The initial step in the evaluation of orbital disease is a complete ophthalmic examination. A careful medical and ophthalmic history, including time course of the disease, past trauma, ocular surgery, and systemic illnesses, must be obtained. A complete clinical examination includes assessment of visual acuity and visual fields, anterior and posterior segment evaluation, and external and periorbital inspection. The use of modern imaging techniques is almost always indicated - the choice depends on the disease processes suspected.

Osteomas are the most common fibro-osseous lesions in the paranasal sinus. They are benign tumours characterized by slow growth and may extend to surrounding structures.

The patients usually presented with severe inferior lateral displacement of the eye ball, superior limitation of ocular motility and sometimes proptosis were detected.

Anteroposterior x-ray of the skull showed a large, dense, mushroom shaped mass projecting into the orbit from the orbital roof.
Axial and coronal computed tomography images revealed a well-defined, multilobulated high density tumor, orginated from the superior wall of the frontal sinus and involving the majority of the anterior superior orbital region. Extension into the orbit with narrow neck was noted.

The choice of surgical management depends on the location, size and experience of the surgeon. An open approach allows tumor removal with direct visual control and remains the best option in large tumors, but the continued progression in endoscopic approaches is responsible for new indications in closed techniques. Immediate reconstruction allows aesthetic and functional restoration of neighbouring structures, which should one of the goals in the treatment of this benign entity.