Purpose or Case Report: Pediatric developmental and non-neoplastic orbital lesions are uncommon. Recognition of the most common pediatric developmental orbital lesions can aid the referring clinician in vision prognostication and prompt a search for other features in syndromic cases. Early recognition of non-neoplastic orbital lesions including infectious/inflammatory lesions, extra-ocular and ocular masses and trauma can direct appropriate and timely subspecialty referral and treatment. A structured approach to multimodality imaging work-up is important for narrowing the differential diagnosis of these lesions. This pictorial essay aims to present a multimodality imaging approach to pediatric developmental and non-neoplastic orbital lesions and highlight the use of ocular ultrasound as a first imaging modality in narrowing the differential diagnosis. We will discuss developmental lesions (persistent hyperplastic primary vitreous, congenital cataracts, coloboma, morning glory disc anomaly, retinopathy of prematurity, microphthalmia and anophthalmia), infectious/inflammatory pathologies (preseptal cellulitis, orbital cellulitis, optic neuritis, chalazion, uveitis, toxocara and toxoplasmosis), extra-ocular non-neoplastic orbital/periorbital pathologies (dermoid cyst, Langerhans cell histiocytosis, thyroid ophthalmopathy, orbital pseudotumor, optic nerve sheath arachnoid cyst), ocular non-neoplastic lesions (drusen and phthisis bulbi) and trauma (orbital blow out fracture, globe rupture, orbital foreign body, globe contusion with hyphema and retinal detachment).
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