Background: Orbital Cavernous hemangiomas are the most common benign, slow growing primary orbital tumor in adults, frequently presenting in middle -age women with progressive painless proptosis. The tumour, represent 5% of orbital masses, sometimes they are described as solitary, encapsulated venous-lymphatic malformations. It typically arises within the muscle cone in 80% of the cases, causing visual impairment or diplopia due to pressure on the optic nerve. Restriction of ocular motility and orbital pain are also documented in several cases even though most cases appear asymptomatic due to its slow progressing characteristic.

Method: Informed consent was obtained from the patient, and ethical approval obtained from the Hospital Ethical Committee. Patient was a 25year old female who presented with a history of painless and progressive right eye protrusion of 4/52 duration, this progresses to become painful with gradual loss of vision, redness and tearing associated with severe generalized headache. Ocular examination reveals unaided visual acuity of 6/6 in both eyes at presentation. However, VA in the RE progressively worsens to CF @3m and no improvement with best correction, lid ecchymosis and severe conjunctival chemosis with gross axial proptosis measuring 28mm, and restriction of ocular motility in all directions.

Dilated fundoscopy reveals pink disc with cup disc ratio of 0.3 in BE, elevated and blurring of disc margin with dilated blood vessels in the RE. Intraocular pressure was 18mmHg and 16mmHg in RE and LE respectively. No associated vascular malformations were identified following systemic review.

Patient had CT scan which showed a lobulated heterogenous hyperdense mass with multiple calcification and hypodense areas occupying the retrobulbar space. The mass is inseparable from the extraocular muscles and obscures the optic nerve.

Result: She had modified exenteration and histology of the tissue which reveals characteristic features of capillary haemangioma.

Conclusion: Computed tomography (CT) is one of the primary imaging modalities used to evaluate orbital tumors and vascular lesions, however, in this case definitive diagnosis was made only following histology.