COTW: Right eye lacrimation and swelling

A 24y/o Male without any significant medical history presents to the ED with persistent tearing of the right eye and now recently noticed swelling near the medial canthus. The differential could include relatively benign conditions such as stye, blepharitis, or cellulitis. However, an Ultrasound found something more concerning.

The above clip shows a normal appearing orbit, with what appears to be a fluid filled, septated, cystic structure medially. Note the fluid-fluid levels present as well. Orbital MRI was consistent with an Aneurysmal bone cyst of the ethmoid sinus. ENT was consulted and the patient was taken to the OR the following day.

This is a great example of how ultrasound lead to a quick diagnosis of an uncommon condition that could have easily been dismissed as something more benign on the first visit.