Orbital encephalocele is a severe and sight-threatening complication of orbital roof fractures. Post-traumatic orbital encephalocele can be challenging to diagnose on CT as patients with this condition often have associated orbital and intracranial hematoma, which can be difficult to distinguish from herniated brain tissue. When there is a high index of suspicion for encephalocele, an MRI of the orbits and brain with contrast should be obtained for additional characterization. Imaging signs that should raise suspicion for traumatic orbital encephalocele include an enlarging heterogeneous orbital mass in conjunction with a roof fracture and/or widening fracture segments.
While intralesional bevacizumab has been utilized as a treatment modality in the use of other squamous tumors, further studies on the use of bevacizumab in squamous neoplasia would be needed to recommend this treatment for the ocular surface. In the absence of further studies, the current topical and intralesional chemotherapeutic agents should continue to be the mainstay of medical treatment for squamous neoplasia; surgical management is still the definitive treatment.
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