cellular subtype. Another classification involves cellular morphology. The 2 patterns of cell morphology are Antoni A and Antoni B. In Antoni A, spindle cells are arranged in "interlacing cords, whorls, or palisades," whereas Antoni B is characterized by "stellate cells, with a mucoid stroma." 1 Treatment of orbital schwannomas is mainly surgical. The surgical approach differs depending on the localization of the tumor 1,4 and may occasionally require an interdisciplinary approach between ophthalmology, otorhinolaryngology, and neurosurgery. Surgical excision is considered a definitive treatment, with recurrence rates being very low. 4,7 In our case, we opted for a superior orbitotomy through a lid-split incision. This approach provided us adequate visualization of the schwannoma, which was in the central, anterior orbit. It also allowed an excellent view of the bony defect of orbital roof in the event a reconstruction was needed. Though rare, potential risks unique to this approach are those involving the eyelid margin, including notching, trichiasis, and irregular contour.We believe the patient's acute presentation of symptomatic diplopia is explained by the intralesional hemorrhage seen on MRI, which may have increased the lesion's size abruptly. It is interesting to note the absence of lid retraction in the patient's postoperative period despite having underwent 2 levator palpebrae resections; we hypothesize that the muscle was mechanically stretched by the tumor throughout the years.We believe our case is unique, given the patient's clinical course as well as the surgical approach through vertical lid-split incision technique. The intraoperative view of the defect in the orbital roof was equally special. We hope this report serves as a reminder to retain diagnostic skepticism in the face of recurrent ptosis and to consider vertical lid-split approach for anterior lesions of the orbit.
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