Abstract
To investigate the clinical and radiologic characteristics, treatment outcomes, and management strategies for orbital incidentalomas. We retrospectively reviewed 43 patients with orbital tumors incidentally identified through imaging conducted for unrelated reasons between March 2015 and July 2023. Data on imaging indications, clinicoradiologic features, diagnoses, treatments, and outcomes were analyzed. Patients were divided into surgery (n = 14, 32.6%) and observation (n = 29, 67.4%) groups for comparison. Among the 43 cases, 20 patients (46.5%) were male, with a mean age of 57.1 years and a mean follow-up of 2.77 years. Initial imaging was most commonly conducted for health check-ups (48.8%), headaches (27.9%), or dizziness (14.0%). Common clinical signs included proptosis (41.9%), peripheral diplopia (21.4%), and hypoglobus (9.3%). Benign lesions, such as cavernous venous malformations (55.8%) and schwannomas (27.9%), predominated, with one case of lymphoma. The surgery group more frequently exhibited clinical signs and anterior tumor locations (71.4% vs. 13.8%, p = 0.001). Surgical excision was successful without complications. In the observation group, tumor stability was noted in 96.6% without functional deficits. Orbital incidentalomas are often benign and asymptomatic. Observation is recommended for asymptomatic posterior orbital lesions, while surgical removal is indicated for anterior lesions with significant clinical signs.
Keywords: Orbital mass, Orbital incidentaloma, Cavernous venous malformation, Schwannoma
Subject terms: Medical research, Signs and symptoms
Introduction
The increasing utilization of imaging modalities for the central nervous system and orbit has led to a rise in the incidental detection of lesions1. The term “incidentaloma” was originally coined to describe an adrenal mass discovered incidentally during imaging for reasons unrelated to suspected adrenal disease2. These incidental lesions can be found in various organs, including the pituitary, thyroid, and salivary glands, paranasal sinuses, pancreas, kidneys, and lungs3,4. However, research on orbital incidentalomas remains relatively limited.
An orbital incidentaloma is defined as a lesion within the orbit detected incidentally through imaging performed for reasons unrelated to a suspected orbital mass. While primary orbital mass lesions are relatively rare, with an incidence of 2.02 per million person-years, incidentalomas in the orbit have been increasingly identified due to the widespread use of various imaging modalities5. Despite their growing recognition, the features and diagnoses of orbital incidentalomas based on radiologic or pathologic findings remain unclear.
Orbital incidentalomas can cause unnecessary anxiety and may lead to unnecessary diagnostic procedures. Some lesions, however, may represent serious conditions, such as primary malignancies, metastatic tumors, or vascular lesions with hemorrhage6. While Melmed et al7. demonstrated that some pituitary incidentalomas remain stable without significant growth over years or even decades, necessitating regular magnetic resonance imaging (MRI) follow-up only in cases of functioning adenomas or specific clinical circumstances, the literature on the long-term follow-up and prognosis of orbital incidentalomas is limited. Therefore, appropriate practice guidelines are warranted.
This study aims to assess the reasons for initial imaging, clinical characteristics, radiological features, treatments, and outcomes of orbital incidentalomas. Furthermore, it seeks to investigate treatment strategies and long-term prognosis for these lesions through extended follow-up.
Methods
We conducted a retrospective analysis of orbital incidentalomas referred to the Department of Ophthalmology at Asan Medical Center, Seoul, Korea, between March 2015 and July 2023. A single senior author (H-SS) evaluated and treated all the patients. This research was approved by the Institutional Review Board (IRB) of Asan Medical Center (Seoul, Korea; IRB number: 2024 − 1462) and complied with the Health Insurance Portability and Accountability Act. The research adhered to the principles of the Declaration of Helsinki. Due to the retrospective nature of the study, the requirement for obtaining informed consent and additional ethical approval was waived by the IRB.
The inclusion criteria for this study comprised patients with orbital tumors incidentally detected during imaging studies conducted for reasons unrelated to suspected orbital disease or metastatic screening, regardless of past oncologic history. Exclusion criteria included patients who presented with ophthalmic symptoms at initial presentation, those who underwent imaging specifically for cancer staging or metastatic workup, those without follow-up imaging, and those with a follow-up period below 6 months. Clinical data collected included demographics, reasons for undergoing imaging, symptoms and signs, ophthalmological findings, radiological characteristics, diagnoses (radiologic or pathological), treatment modalities, and outcomes.
We analyzed the initial imaging findings of all patients and performed additional orbital MRI when the initial imaging lacked sufficient detail for a comprehensive assessment. Tumor characteristics assessed included size, location, shape (categorized as oval, lobulated, multi-lobulated, round, elongated, or irregular), and T2 signal intensities. Tumor size was determined by measuring the maximum diameter of the largest mass. Orbital lesions were classified as intraconal or extraconal based on their location relative to the muscle cone, as anterior or posterior according to their position relative to the globe’s equator, and further assigned to orbital quadrants (superomedial, superolateral, inferomedial, or inferolateral) based on their axial location8. Management plans were established based on clinical assessments by surgeons and patients’ individual needs. Surgical intervention was indicated for cases presenting with eyeball displacement (e.g., proptosis or hypoglobus), suspected malignancy requiring biopsy, discomfort due to peripheral diplopia or visual disturbance, or when the patient’s preference for removal and the surgeon’s assessment of surgical feasibility were satisfied. We classified patients into two groups: the surgery group, comprising those who underwent surgical excision of the tumors, and the observation group, comprising those monitored with regular imaging without surgery. Clinical and radiological characteristics were compared between these two groups.
Statistical analysis was performed using IBM SPSS Statistics (Version 26.0; IBM Corp., Armonk, NY, USA). Ordinal data and continuous variables are presented as medians with their respective minimum-maximum ranges. Logistic regression models were employed to assess the associations between tumor size, location, and the necessity for surgical resection. The Chi-square (χ2) test and analysis of variance (ANOVA) (for normally distributed data) were used to compare categorical data. A p-value < 0.05 was considered statistically significant.
Results
Forty-three patients were retrospectively assessed. Table 1 summarizes the clinical data of orbital incidentalomas. The median age was 57.1 years (3–75 years), and 20 patients (46.5%) were male. The median follow-up time was 2.77 years (0.8–10.6 years). The primary reasons for performing imaging tests included health check-ups (21/43, 48.8%), headaches (12/43, 27.9%), dizziness (6/43, 14.0%), blunt head trauma (3/43, 7.0%), and general weakness (1/43, 2.3%). At presentation, patients with orbital incidentalomas did not report any ocular symptoms; however, ophthalmological examination revealed various signs, including proptosis (≥ 2 mm) (18/43, 41.9%), peripheral diplopia (beyond 30°) (9/43, 21.4%), hypoglobus (≥ 2 mm) (4/43, 9.3%), palpable mass (2/43, 4.7%), visual field defects (2/43, 4.7%), upper eyelid edema (1/43, 2.3%), optic disc edema (1/43, 2.3%), and pupil defects (1/43, 2.3%).
Table 1.
Clinical characteristics of orbital incidentalomas.
| Clinical characteristics | N = 43 | |||
|---|---|---|---|---|
| Age at diagnosis, years | 57.1 ± 10.8 | |||
| Sex, no (%) | Male | 20 (46.5%) | ||
| Female | 23 (53.5%) | |||
| Reasons for performing imaging test | Health screening | 21 (48.8%) | ||
| Headache | 12 (27.9%) | |||
| Dizziness | 6 (14.0%) | |||
| Blunt head trauma | 3 (7.0%) | |||
| General weakness | 1 (2.3%) | |||
| Ophthalmological signs, no (%) | Proptosis | Mild (2 ≤ ≤ 3 mm) | 13 (30.2%) | |
| Moderate (3 < ≤ 5 mm) | 3 (7.2%) | |||
| Severe (> 5 mm) | 2 (4.7%) | |||
| Peripheral diplopia (beyond 30°) | 9 (21.4%) | |||
| Hypoglobus (≥ 2 mm) | 4 (9.3%) | |||
| Visual field defect | 2 (4.7%) | |||
| Palpable mass | 2 (4.7%) | |||
| Upper eyelid edema | 1 (2.3%) | |||
| Optic disc edema | 1 (2.3%) | |||
| Pupil defects | 1 (2.3%) | |||
Table 2 summarizes the radiologic characteristics of orbital incidentalomas. Among the 43 cases, the radiologic or pathological diagnoses included cavernous venous malformation (CVM) (24/43, 55.8%), schwannoma (12/43, 27.9%), dermoid cyst (2/43, 4.5%), and lymphoma, lymphangioma, fibrous dysplasia, optic glioma, and meningioma (1/43, 2.3% each). The mean tumor size was 16.3 mm (5–40 mm). Tumor locations were more commonly posterior (30/43, 69.8%) than anterior (13/43, 30.2%), and intraconal tumors (31/43, 72.1%) were more frequent than extraconal ones (12/43, 27.9%). By orbital quadrants, superolateral lesions (13/43, 30.2%) were the most common, followed by superomedial lesions (12/43, 27.9%). The most common shape of orbital incidentalomas was oval (26/43, 60.5%), followed by lobulated (6/43, 14.0%). Most tumors were well-circumscribed, with three exceptions: lymphoma, fibrous dysplasia, and optic glioma, which exhibited irregular shapes.
Table 2.
Radiologic characteristics by diagnosis of orbital incidentalomas.
| Cavernous venous malformation | Schwannoma | Dermoid cyst | Lymphoma | Lymphangioma | Fibrous dysplasia | Optic glioma | Meningioma | Total | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Number of patients | 24 (55.8%) | 12 (27.9%) | 2 (4.7%) | 1 (2.3%) | 1 (2.3%) | 1 (2.3%) | 1 (2.3%) | 1 (2.3%) | 43 (100%) | |
| Tumor size | 16.8 ± 6.5 | 15.8 + 8.9 | 10.0 ± 1.4 | 15 | 40 | 10 | 10 | 11 |
16.3 ± 7.7 (mean size) |
|
| Tumor location | Anterior | 7 (16.3%) | 4 (9.3%) | 0 (0%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 13 (30.2%) |
| Posterior | 16 (37.2%) | 8 (18.6%) | 2 (4.7%) | 1 (2.3%) | 0 (0%) | 1 (2.3%) | 1 (2.3%) | 0 (0%) | 29 (67.4%) | |
| Anterior to posterior | 1 (2.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2.3%) | |
| Tumor position | Intraconal | 20 (46.5%) | 7 (16.3%) | 1 (2.3%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 1 (2.3%) | 1 (2.3%) | 31 (72.1%) |
| Extraconal | 4 (9.3%) | 5 (11.6%) | 1 (2.3%) | 1 (2.3%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 12 (27.9%) | |
| Tumor shape | Ovoid | 16 (37.2%) | 7 (16.3%) | 2 (4.5%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2.3%) | 26 (60.5%) |
| Lobulated | 4 (9.3%) | 2 (4.5%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 6 (14.0%) | |
| Multi-lobulated | 4 (9.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 5 (11.6%) | |
| Round | 0 (0%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2.3%) | |
| Elongated | 1 (2.3%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 2 (4.5%) | |
| Irregular lesion | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 1 (2.3%) | 1 (2.3%) | 0 (0%) | 3 (7.0%) | |
| T2 signal intensity | High | 19 (44.2%) | 8 (18.6%) | 0 (0%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 1 (2.3%) | 1 (2.3%) | 30 (70.7%) |
| Intermediate | 5 (11.6%) | 2 (4.7%) | 2 (4.7%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 10 (23.3%) | |
| Low | 0 (0%) | 2 (4.7%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2.3%) | 0 (0%) | 0 (0%) | 3 (7.0%) | |
In the surgery group (14/43, 32.6%), surgery included tumor excision (13/43, 30.2%) or incisional biopsy for suspected malignancy (1/43, 2.3%). Indications for surgery included proptosis (≥ 2 mm) (8/14, 57.1%), hypoglobus (2/14, 14.3%), peripheral diplopia (2/14, 14.3%), biopsy for suspected malignancy (1/14, 7.1%), and a palpable mass (1/14, 7.1%). No surgery-related complications were observed. Pathological diagnoses included CVM (n = 7), schwannoma (n = 5), lymphoma (n = 1), and fibrous dysplasia (n = 1). One case initially diagnosed radiologically as CVM was later confirmed pathologically as schwannoma. The patient with biopsy-confirmed low-grade extranodal marginal zone lymphoma showed no systemic involvement, underwent radiation therapy, and achieved complete remission without relapse. Among the 12 cases of surgical excision for CVM or schwannoma, no recurrences were observed during a median follow-up of 2.53 years (0.8–3.2 years).
For the observation group (29/43, 67.4%), all patients were monitored during a median follow-up of 2.77 years (1.4–6.2 years) following the initial diagnosis. Ophthalmological examinations and orbital imaging were performed at each visit to evaluate functional status and tumor size changes. Reasons for observation without surgery included concern for complications due to tumor proximity to the optic nerve (13 cases, 44.9%), no symptoms or signs (10 cases, 34.5%), posterior tumor location with challenging surgical access (8 cases, 27.6%), and patient refusal of feasible surgery (2 cases, 6.9%). During follow-up, most patients (26/29, 89.7%) exhibited no changes in tumor size or development of new functional deficits (Fig. 1). Tumor size changes were observed in three patients (10.3%): one CVM case exhibited 12% growth (from 17 to 19 mm) over 48 months, while two cases showed tumor reduction— a 25% decrease (from 40 to 30 mm) in lymphangioma at 38.3 months, and a 20% decrease (from 20 to 16 mm) in schwannoma at 22.4 months. Notably, none of the patients in the observation group required conversion to surgical treatment.
Fig. 1.
(A) MRI at initial presentation supporting the diagnosis of orbital cavernous venous malformation. (B) MRI after 2 years showing no mass growth during the observation period.
Table 3 presents and compares the clinical and radiological characteristics of the observation and surgery groups. For ophthalmological signs, proptosis, peripheral diplopia, hypoglobus, and palpable mass were significantly more common in the surgery group than in the observation group (p < 0.001, p = 0.014, p = 0.003, and p = 0.037, respectively). The mean tumor size was larger in the surgery group (19.36 mm) compared to the observation group (14.76 mm), with no significant difference (p = 0.072). Additionally, tumor location differed significantly between the two groups: 71.4% of tumors in the surgery group were located in the anterior orbit, while 86.2% of tumors in the observation group were located in the posterior orbit (p = 0.001). No significant differences were observed in tumor position (intraconal vs. extraconal) or shape between the two groups.
Table 3.
Comparison of clinical and radiological characteristics between observation and surgery groups of orbital incidentalomas.
| Surgery (n = 14) |
Observation (n = 29) |
p-value | |
|---|---|---|---|
| Ophthalmological signs | |||
| Proptosis (≥ 2 mm) | 12 (85.7%) | 6 (20.7%) | < 0.001 |
| Peripheral diplopia (beyond 30°) | 6 (42.9%) | 3 (10.3%) | 0.014 |
| Hypoglobus (≥ 2 mm) | 4 (28.6%) | 0 (0%) | 0.003 |
| Palpable mass | 2 (14.3%) | 0 (0%) | 0.037 |
| Visual field defect | 1 (7.1%) | 1 (3.4%) | 0.590 |
| Upper eyelid edema | 0 (0%) | 1 (3.4%) | 0.482 |
| Optic disc edema | 1 (7.1%) | 0 (0%) | 0.145 |
| Pupil defects | 1 (7.1%) | 0 (0%) | 0.145 |
| Tumor size, mm | 19.36 ± 6.01 | 14.76 ± 8.29 | 0.072 |
| Tumor location | |||
| Anterior (n = 14) | 10 (71.4%) | 4 (13.8%) | 0.001 |
| Posterior (n = 28) | 4 (28.6%) | 24 (82.8%) | |
| Anterior + posterior (n = 1) | 0 (0%) | 1 (3.4%) | |
| Tumor position | |||
| Intraconal (n = 31) | 9 (64.3%) | 22 (75.9%) | 0.428 |
| Extraconal (n = 12) | 5 (35.7%) | 7 (24.1%) | |
| Tumor shape | |||
| Ovoid | 10 (71.4%) | 16 (55.2%) | 0.335 |
| Lobulated | 1 (7.1%) | 5 (17.2%) | |
| Multi-lobulated | 3 (21.4%) | 2 (6.9%) | |
| Round | 0 (0%) | 1 (3.4%) | |
| Elongated | 0 (0%) | 2 (6.9%) | |
| Irregular lesion | 2 (14.3%) | 1 (3.4%) | |
Discussion
This study investigated the clinical and radiologic characteristics and management outcomes of orbital incidentalomas in 43 patients, with a median follow-up of 2.8 years. Our findings revealed that orbital incidentalomas were typically identified during imaging performed for health check-ups (49%) or neurological evaluations (42%). The most common diagnoses were CVM (56%) and schwannoma (28%), although a malignant tumor, such as lymphoma, was also detected. None of the patients reported subjective symptoms before diagnosis; however, ophthalmological examinations frequently revealed various signs, such as proptosis (42%), peripheral diplopia (21%), and hypoglobus (10%). We found that most orbital incidentalomas remained stable in size, with only one case (3%) showing minimal growth on follow-up imaging. For incidentalomas in the posterior orbit without significant ophthalmological signs or functional deficits, conservative observation appears to be a reasonable and safe management strategy. In contrast, surgical removal may be considered for anterior orbital lesions due to the typically low risk of complications.
In our study, orbital incidentalomas were predominantly detected during routine health check-ups or neuroimaging studies conducted for unrelated conditions. With improved access to healthcare and increasing use of such tests, the detection of orbital incidentalomas is expected to rise, highlighting the need for a better understanding of their characteristics, clinical courses, and management strategies. Notably, CVMs and schwannomas were our study’s most commonly identified incidentalomas, consistent with previous reports9. CVMs are recognised as the most common benign orbital tumors in adults, while schwannomas, arising from peripheral nerves, may also occur without obvious clinical symptoms9,10. The predominance of these lesions reflects not only their high prevalence but also their characteristic growth patterns and benign nature, often allowing them to remain asymptomatic until discovered incidentally. Radiologically, these lesions typically appear as benign, ovoid or elongated masses, predominantly in the posterior intraconal space, with high T2-weighted signal intensity11,12. Previous studies have emphasized the accuracy of radiological diagnosis for CVMs and schwannomas, often eliminating the need for diagnostic surgery11,13,14. Advanced imaging techniques, such as diffusion-weighted MRI, provide valuable information, particularly in distinguishing benign from potentially aggressive pathologies. These findings underscore the critical role of imaging in guiding clinical decisions and supporting conservative management, especially for asymptomatic cases with benign characteristics.
The anatomical location of orbital lesions significantly influences the clinical symptoms and signs15. In our study, the most common clinical sign was proptosis (42%), followed by peripheral diplopia (21%) and hypoglobus (9%). Notably, approximately 70% of orbital incidentalomas were in the posterior orbit and intraconal space. Small masses in the posterior orbit are often asymptomatic unless apical lesions cause compressive optic neuropathy. However, as these masses increase in size, posterior and intraconal masses can exert pressure along the visual axis, leading to forward displacement of the globe and manifesting as proptosis. This explains why orbital incidentalomas are more commonly found in the posterior orbit, often presenting with gradual and mild proptosis that patients may not initially notice. In contrast, anteriorly located lesions, particularly those near the globe or extraocular muscle, tend to displace ocular structures to the opposite side of the lesion, resulting in hypoglobus, peripheral diplopia, or the presence of a palpable mass. Although patients did not initially recognise these clinical signs before incidental detection, many became more aware of and concerned about these symptoms after diagnosis compared to mild proptosis. This difference appeared to influence patients’ decisions regarding surgical management. Additionally, although observed in a small number of cases, some patients exhibited visual field defects (5%), optic disc edema (2%), or pupil defects (2%). These findings highlight the potential for orbital incidentalomas to cause significant ocular deficits and the necessity of ophthalmological follow-up.
Our study presented various management strategies for orbital incidentalomas, including observation, surgery, or diagnostic biopsy, depending on factors such as clinical symptoms, tumor size, location, radiologic diagnosis, and surgical risks16,17. In our study, one-third of patients underwent surgery or biopsy for orbital incidentalomas. The decision to proceed with surgery was primarily based on concerns about potential malignancy, the presence and severity of ophthalmological signs, and an assessment of surgical risks. We performed an incisional biopsy to differentiate malignancy in one case with an irregular tumor shape observed on imaging, and pathological results confirmed lymphoma. For radiologically benign lesions, the surgery group was significantly more likely to exhibit ophthalmological signs, including proptosis, peripheral diplopia, hypoglobus, and palpable mass (all p < 0.05). Many patients became concerned about previously unnoticed symptoms after diagnosis, which influenced their preference for surgery. This post-diagnostic symptom perception likely reflects the interplay between medical information and patient psychology—a factor not widely addressed in previous studies. Additionally, 71% of tumors in the surgery group were located anteriorly, while 86% in the observation group were located posteriorly, demonstrating a significant difference (p = 0.001). These findings suggest that the anterior orbital incidentalomas are more likely to cause functional or cosmetic deficits but pose better surgical feasibility and lower complication risks. Tumor size was larger in the surgery group compared to the observation group but without statistical significance (p = 0.072), and no significant difference in tumor position (intraconal vs. extraconal) was observed. These results suggest that the severity of ophthalmological signs, patient perceptions, and surgical feasibility are more important factors than tumor size in the surgery decision-making process.
In our study, two-thirds of patients were managed without surgery for a median follow-up of 2.77 years and showed no development of new functional deficits. All patients in the observation group declined surgical excision of the incidentaloma as they were not bothered by the ophthalmological signs such as proptosis and peripheral diplopia. Most cases (25/29, 86%) had posterior orbital lesions, bearing more potential surgical risks. During the median follow-up period, most lesions (28/29, 96.6%) remained stable in size and morphology, including two cases (one lymphangioma and one schwannoma) showing a decrease in size. Although spontaneous regression of orbital schwannoma is rare, it has been reported in the literature at vestibular schwannoma18. Proposed mechanisms include cystic degeneration, ischemic changes, or resorption of intralesional hemorrhage, which may lead to a decrease in tumor volume without intervention. In our case, the reduction in size may also reflect such internal changes. Only one CVM case showed minimal growth during follow-up without any functional deficits. These findings highlight that conservative management is often appropriate for orbital incidentalomas rather than surgical removal, particularly for posterior lesions without significant signs.
Our study had several limitations. First, the retrospective design, small sample size, and variation in follow-up duration limit our findings’ generalisability. Nevertheless, this study represents the first retrospective review of orbital incidentalomas, highlighting the need for further research to validate and expand upon these initial observations. Second, two cases where tumor removal was expected to yield favourable outcomes were not treated, as the patients declined surgery. This may have affected our ability to evaluate comparisons between the surgery and observation groups. The lack of a standardised protocol for managing orbital incidentalomas resulted in treatment decisions being influenced by individual clinicians’ judgments and patients’ preferences, potentially introducing variability in management approaches. In this study, we adopted a practical approach based on our clinical experience and comprehensive counselling with each patient regarding potential surgical complications before finalising their decisions. Importantly, no adverse clinical outcomes were observed in patients who underwent surgery or those who opted for conservative management. However, we recognize that surgical decisions could be affected by the level of medical institution and the surgeon’s experience. Lastly, although some patients exhibited subtle clinical signs such as mild proptosis or diplopia at the time of ophthalmologic evaluation, these signs were not recognized by the patients and did not prompt the imaging studies. As such, we classified these lesions as incidentalomas based on the absence of clinical suspicion prior to imaging, a definition consistent with accepted criteria used in other organ systems19. Nonetheless, this definitional nuance may limit direct comparison with studies that apply stricter criteria for asymptomatic status.
In conclusion, our findings suggest that orbital incidentalomas are often benign and asymptomatic, and their prevalence is expected to increase due to the growing demand for health check-ups and neuroimaging. Most orbital incidentalomas remain stable in size over time and typically do not require surgery. Observation proves to be a practical management strategy for asymptomatic lesions, particularly those located posteriorly and intraconally. Surgical intervention should be reserved for symptomatic lesions or those located anteriorly, where safe excision is more feasible. Future studies are needed to assess the incidence and establish specific guidelines for the management and follow-up of orbital incidentalomas based on their individual characteristics.
Author contributions
Concept and design: HSS and YC. Analysis and interperetation of data: YC and MY. Drafting the article or revising it critically for important intellectual content: all authors. Final approval of the version to be published: HSS.
Data availability
Data are available upon reasonable request (Corresponding author: Ho-Seok Sa, e-mail: lineblue@hanmail.net, ORCID 0000-0003-3043-7222).
Declarations
Competing interests
The authors declare no competing interests.
Ethics approval
Institutional review board approval was obtained, and the study was performed in accordance with the principles of the Declaration of Helsinki.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are available upon reasonable request (Corresponding author: Ho-Seok Sa, e-mail: lineblue@hanmail.net, ORCID 0000-0003-3043-7222).