Adult Subconjunctival Hemangioma Presenting as Isolated Exophthalmos and Mimicking Lacrimal Dacryops: A Case Report

Abstract

Aims: This case report describes an unusual presentation of adult subconjunctival haemangioma that manifested as isolated unilateral exophthalmos and radiologically mimicked lacrimal dacryops. Presentation of Case: A 39-year-old woman presented with progressive, painless right-sided exophthalmos of 5 months’ duration. There was no history of trauma, acute inflammation, diplopia, ocular pain, or visual loss. Ophthalmic examination showed preserved visual acuity, full ocular motility, and dry eye syndrome. No visible subconjunctival mass, conjunctival discoloration, episcleral vessel dilation, chemosis, or localised inflammatory change was identified. Clinical photography demonstrated mild axial right exophthalmos. Orbito-cerebral computed tomography and magnetic resonance imaging revealed a cystic-appearing lesion in the anatomical region of the right lacrimal gland. The lesion had fluid-like content, a thin regular wall, and peripheral enhancement after contrast administration. It measured 23 × 14 mm in the axial plane and 21 mm in height, with mass effect on the ipsilateral globe but no retro-orbital fat infiltration, bone erosion, or intracranial abnormality. Dacryops or a cystic lacrimal gland tumour was initially suspected. Surgical biopsy was therefore performed. Histopathological examination showed a benign subconjunctival vascular proliferation composed of small vascular channels lined by swollen endothelial cells within an oedematous and congestive stroma. No ductal or glandular epithelial structures, cytological atypia, malignant features, or deep lacrimal parenchymal involvement were identified. The final diagnosis was subconjunctival haemangioma with a prominent oedematous-congestive component. Systemic corticosteroid therapy was followed by progressive regression of the exophthalmos. Conclusion: Adult subconjunctival haemangioma may rarely present without a clinically visible conjunctival lesion and may mimic cystic lacrimal gland pathology on imaging. Histopathological confirmation is important when clinical and radiological findings are discordant.