Fig. 10. A 61-year-old man presented with a chronic draining fistula (arrow) of the left lower lid and medial canthal region. It was associated with limitation of abduction, a palpable mass in the inferomedial orbit, and a papillary reaction of the medial conjunctiva(inset). Coronal CT scan demonstrates an inferomedial infiltrating orbital mass. On biopsy, it proved to be a poorly differentiated squamous cell carcinoma arising from the mucous epithelium of either the conjunctiva or lacrimal sac. The patient refused exenteration and underwent radical radiotherapy (60 Gy in 25 fractions over 5 weeks). Seven years later, he remained free of disease, although the radiated eye is scarred and shrunken. (Rootman J, Ragaz J, Cline R, Lapointe JS: Metastatic and secondary tumors of the orbit. In Rootman JR (ed): Diseases of the Orbit: A Multidisciplinary Approach, pp 405–427. Philadelphia, JB Lippincott, 1988.)