MS is a 4-year-old child with a history of progressive left upper lid swelling over several weeks. Examination of the eyes was unremarkable except for moderate nontender edema of the lid. The parents stated that the child had not complained of pain in that area at any time. A CT scan showed enlargement of the left lacrimal gland without apparent involvement of the orbital bone. The differential diagnosis included a solid tumor such as a pleomorphic adenoma, lymphoma, and pseudotumor. An oculoplastic surgeon was consulted and was concerned that the lack of pain and tenderness supported a solid tumor of the gland as compared to an inflammatory process.
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