Orbital
A benign orbital lymphatic malformation, present from birth, that can enlarge suddenly with infection or bleed into a chocolate cyst — causing proptosis that can threaten vision.
Medically reviewed by Jon Caster, MDOculoplastic SurgeonLast updated June 2026
An orbital lymphangioma — more precisely called a lymphatic malformation — is a benign, non-cancerous tangle of abnormal lymphatic channels inside the eye socket. It is present from birth, most often becomes apparent in childhood, and behaves unpredictably: it can stay quiet for long periods, then suddenly enlarge, especially during an upper respiratory infection or if it bleeds internally. Because it sits within the confined space of the orbit, even a benign lesion can push the eye forward and threaten vision when it expands.
This is a focused companion to our Orbital Tumors guide and our Pediatric Orbital Tumors guide, where lymphatic malformation is one of the more common childhood orbital masses.
A lymphatic malformation is made of thin-walled lymphatic (and often small blood) channels that do not connect normally to the circulation. This structure explains its two characteristic patterns:
Between these episodes the lesion may be stable and cause few symptoms. This on-again, off-again course is a hallmark that helps distinguish it from other orbital masses.
Depending on size and location, an orbital lymphatic malformation can cause:
In any child with proptosis, the priority is to distinguish a benign lesion like this from the mimics that demand urgent action — particularly orbital cellulitis (an infection) and rhabdomyosarcoma (the most common primary orbital cancer of childhood). Imaging and specialist evaluation sort these out.
Diagnosis relies on imaging — MRI is especially useful for showing the cystic, multi-compartment structure and any fluid-fluid levels from prior bleeding that are characteristic of a lymphatic malformation. Imaging also maps how the lesion wraps around the eye, muscles, and optic nerve, which is essential for planning any intervention.
Because these lesions infiltrate around delicate orbital structures rather than forming a neat, removable ball, treatment is deliberately conservative and tailored:
Care is often shared between an oculoplastic/orbital surgeon and an interventional specialist, and the plan is matched to the child's symptoms and the lesion's behavior over time.
Any bulging of a child's eye — particularly if it comes on suddenly or fluctuates with colds — warrants prompt orbital evaluation. If bulging is sudden and accompanied by decreased vision or significant pain, seek emergency care the same day, as pressure on the optic nerve can permanently damage sight within hours to days. An ASOPRS-trained oculoplastic surgeon working with pediatric and imaging specialists can confirm the diagnosis and guide treatment that protects the eye and vision.
A bulging or fluctuating eye in a child needs orbital expertise
Orbital lymphatic malformations are benign but unpredictable — specialist evaluation protects vision. Find an ASOPRS-trained oculoplastic surgeon near you.
Schedule a consultation with Jon Caster, MD to learn if this procedure is right for you.
