|Periocular ecchymosis, a purple discoloration of the periocular skin due to the extravasation of blood into the subcutaneous tissues, is most commonly found in the setting of periorbital trauma and surgery. Capillary hemangioma is a proliferation of vascular endothelial cells and pericytes forming a capillary unit. Lymphangioma is a rare hamartoma composed of lymphatic and venous vasculature that represents 5.6% of benign childhood tumors. Orbital varix, composed of dilated venous channels, is another benign vascular growth in children and represents 2% of orbital tumors. Neuroblastoma is an aggressive pediatric sympathetic nervous system malignancy that arises from neural crest cells in the adrenal medulla or paraspinal sympathetic tissue. Acute leukemia, the malignant proliferation of lymphocytes, is the most common pediatric malignancy, with peak incidence at 2-5 years of age. Spontaneous periocular ecchymosis in children elicits a broad differential diagnosis of vision-threatening and life-threatening conditions that often necessitate the collaboration of multiple pediatric disciplines.
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