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To calculate the contemporary incidence and morbidity associated with unexpected asymptomatic orbital lesions found on craniofacial imaging.

A retrospective analysis was performed of all patients discussed at North West Orbital Multidisciplinary Team (MDT) Meetings at Manchester Royal Eye Hospital from April 2015 to March 2019. Patients without symptoms of orbital disease but reported to have orbital lesions on MRI or CT craniofacial imaging were included.

265 cases were reviewed over the 4-year study period covering a geographical population of approximately 5.5million. 14 cases of orbital incidentaloma were found i.e. 5% of cases discussed at the NW Orbital MDT. The incidence of orbital incidentaloma was therefore 0.6 cases per 1 million population per year. Mean age was 63 years (range 38 to 90 years). The original scan indications included TIA, progressive visual field loss, acute confusion, falls, hearing loss, headache, tinnitus and recent cardiopulmonary resuscitation. Radiological orbital diagnoses matched with clinical findings included vascular lesion (8), pleomorphic adenoma (2), optic nerve sheath meningioma (1), dermoid cyst (1), malignant melanoma metastasis (1) and radiological misdiagnosis (1). All cases were unilateral. Two patients required lesion excision via lateral orbitotomy, one required orbital biopsy and one died shortly after imaging due to widespread malignant melanoma metastases. All other patients received clinical monitoring with or without further imaging.

Asymptomatic incidental orbital lesions are a rare phenomenon but can trigger diagnostic and clinical management conundrums. Orbital MDT Meetings provide a safe and effective means of managing such uncertainty.