[TAG:2]Answers[/TAG:2]

1. Clinical features of abaxial proptosis with pale optic disc and imaging features of a well-defined hyperdense lesion arising from the ethmoid bone pushing optic nerve and globe temporally are suggestive of osteoma arising from ethmoid bone of the left orbit
2. Minimal manipulation surgery can be performed by transcaruncular approach. In this case, the mass was excised in toto using the transcaruncular approach with a chisel and hammer. At the end of surgery, ethmoid sinus was intact with no medial wall dehiscence, thus avoiding direct sino-orbital contact
3. Histopathology (H and E stain, ×10) shows dense, compact bone with paucicellular fibrous stroma suggestive of osteoma.

Orbital osteomas are rare and represent only <0.5%–2% of all orbital tumors.^[1] Osteomas are slow-growing, benign lesions. They affect the cortex and metaphyseal region of the bones and have limited growth potential.^[1] Hallmark of osteomas is severe paroxysmal pain which responds to medication.^[1] The osteomas can be sessile, pedunculated, or dumbbell shaped, with or without thin cartilaginous covering, homogenous or heterogenous.^[1] In our case, the lesion was a sessile homogenous osteoma without any cartilaginous covering. When symptomatic, the osteomas are best managed by surgery. Surgical approach for osteoma is based on the size, location, and extension of the lesion and whether the lesion sessile, pedunculated, or dumbbell shaped. The surgical approaches vary and can be as extensive as a coronal approach to the lesion along with patching using a graft to cover the defect.^[1],[2] Ethmoidal osteomas extend medially into the orbit and are in proximity to the optic nerve. Excision is needed if they cause dystopia or diminution of vision due to optic nerve compression.^[1] In this case, we performed excision of the ethmoidal osteoma using a chisel and hammer using the transcaruncular approach with no medial wall dehiscence. Using this technique, we achieved cosmetically and functionally good outcomes.

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Financial support and sponsorship

The study was supported by The Operation Eyesight Universal Institute for Eye Cancer (SK) and Hyderabad Eye Research Foundation (SK), Hyderabad, India.

Conflicts of interest

There are no conflicts of interest.