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Case Quiz: Strawberry Eyes

Case study by Josemaria Castro, ophthalmology resident, the Philippines

A six-month-old female patient presenting with generalized papulovesicular rashes and areas of periorbital and lid swelling with telangiectasia (see Figures 1, 2, 3).


  1. If you are considering a neoplasm, what is the most common benign periorbital tumor in this age group?
  2. If you are considering a metastatic process, what is the most common extracranial tumor that can affect the orbit in this age group?
  3. Given the characteristic disseminated rashes with the presence of Birbeck granules on histologic examination and multiple periorbital masses, what is the likely diagnosis of this case?

Scroll down to check your answers.

Figure 1

Figure 2

Figure 3

The Case Reports in Ophthalmology Meeting is organized by the Foundation for the Development of Ophthalmology “Ophthalmology 21,” together with the University of Warmia and Mazury in Olsztyn, Poland, since 2016. This is an online global meeting featuring short, puzzle-like, and educational case reports. We are very happy to share the most interesting cases with The Ophthalmologist in quiz form.

The Case Reports in Ophthalmology Meeting 2023 is scheduled for November 17, 2023, and is open for case submission and registration: [email protected].

Co-Organizer from The Philippines, Perfecto Cagampang III, comments, “The Case Reports 2022 virtual conference organized by Foundation ‘Ophthalmology 21’ – with its participatory nature – has been an excellent platform for ophthalmology residents to hone their skills of presenting cases in an eloquent manner.”

Andrzej Grzybowski, CEO, Foundation “Ophthalmology 21.”


  1. Capillary hemangioma
  2. Neuroblastoma
  3. Orbital metastatic, likely from Langerhans cell histiocytosis.
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About the Author
Andrzej Grzybowski

Andrzej Grzybowski is a professor of ophthalmology at the University of Warmia and Mazury, Olsztyn, Poland, and the Head of Institute for Research in Ophthalmology at the Foundation for Ophthalmology Development, Poznan, Poland. He is EVER President, Treasurer of the European Academy of Ophthalmology, and a member of the Academia Europea. He is a member of the International AI in Ophthalmology Society ( and has written a book on the subject that can be found here:

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