Orbital Cholesterol Granuloma: Report of Two Cases

PURPOSE: To report two rare cases of orbital cholesterol granuloma (CG) presenting with ptosis and proptosis. METHODS: The first case was a 31-year-old male presented with progressive ptosis of the left eye (LE) during the past year and the second case was a 35-year-old male presented with proptosis of the right eye (RE) for 5 months ago. Orbital computed tomography revealed a cystic well-demarcated lesion in the superotemporal orbit with adjacent bone erosion in the LE of the first case and the RE of the second case. RESULTS: In both cases, the tumor was excised completely through an anterolateral orbitotomy approach. Histopathological evaluation showed fibroconnective tissue with cholesterol clefts surrounded by granulomatous inflammation consistent with the diagnosis of CG. The symptoms of patients were resolved after surgery. CONCLUSIONS: CG of the orbit is a rare lesion that commonly occurred in the superotemporal area. Erosive bone expansion is the characteristic finding of this lesion that can be mistaken with lacrimal gland malignancies. Hence, it is essential to keep CG in mind in the differential diagnosis of lacrimal gland masses.