Purpose To investigate the clinical and radiologic characteristics, treatment outcomes, and management strategies for orbital incidentalomas.

Materials and methods 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 categorized into the surgery and observation groups, and their clinical and radiological characteristics were compared.

Results 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. Patients in the surgery group (n=14, 32.6%) were significantly more likely to present with clinical signs, including proptosis, diplopia, and hypoglobus (all p<0.05), and have anterior tumor locations (71.4% vs. 13.8%, p=0.001) compared to the observation group (n=29, 67.4%). Surgical removal was performed without complications in all cases. In the observation group, tumor size remained stable in 96.6% of cases, with no functional deficits identified throughout follow-up.

Conclusion Orbital incidentalomas are often detected during health check-ups or neuroimaging and may exhibit mild proptosis or diplopia. Observation is recommended for asymptomatic posterior orbital lesions, while surgical removal is indicated for anterior lesions with significant clinical signs.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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