Intraocular Leiomyoma
All content on Eyewiki is protected by copyright law and the Terms of Service. This content may not be reproduced, copied, or put into any artificial intelligence program, including large language and generative AI models, without permission from the Academy.
Disease Entity
Disease
Intraocular leiomyoma is an uncommon benign smooth muscle tumor that can originate from various ocular structures. [1] These tumors are categorized by their embryological origin into mesectodermal leiomyomas, derived from neural crest cells, and mesodermal leiomyomas, which arise from smooth muscle surrounding blood vessels. [2] The designation “mesectodermal leiomyoma” is specific to tumors demonstrating both muscular and neural differentiation on histopathological examination. [3] The ciliary body is the most common site for intraocular leiomyomas, followed by the iris and choroid; these tumors are among the rarest intraocular neoplasms. [1]
Etiology
The etiology of intraocular leiomyoma is linked to its origin from smooth muscle tissue within the eye. The smooth muscle of the iris and ciliary body is embryologically distinct from that in other body parts; while the latter originates from the mesoderm, the former is thought to arise from the neural crest (the mesectoderm). [4] Mesectodermal leiomyoma of the ciliary body, considered to embryologically originate from the neural crest (ectoderm), is an exceptionally rare and apparently benign intraocular tumor. [5]
Structures from which intraocular leiomyomas can develop include:
• Sphincter and dilator muscles of the iris (neuroectodermal origin)[6]
• Smooth muscle of the ciliary body (neural crest origin)[3]
• Smooth muscle surrounding intraocular blood vessels (mesodermal origin)[2]
• Heterotopic smooth muscle in the choroid[2]
Risk Factors
Several demographic and hormonal factors appear associated with intraocular leiomyoma:
Gender: A female predominance is observed, with women affected nearly twice as often as men. Ciliary body leiomyomas particularly show this trend, with one study identifying 51 women and 29 men among its cases. [1]
Age: The mean age at presentation is approximately 35.8 years (median 30.5 years, range 8-80 years). [1]These tumors typically manifest in young to middle-aged adults, a contrast to uveal melanoma, which generally occurs in older individuals. [7]
Hormonal factors: The observed female predominance and the expression of sex steroid hormone receptors in these tumors suggest hormonal influences, analogous to uterine leiomyomas. This raises the possibility of hormonal contributions to tumorigenesis and the potential for hormone manipulation therapy. [8]
Systemic associations: While an infrequent association with systemic fibroids exists, the nuclear expression of sex steroid receptors in intraocular leiomyomas has been inconsistent. [1]
General Pathology
Intraocular leiomyomas are well-circumscribed, benign tumors composed of smooth muscle spindle cells arranged in intersecting fascicles. [3] Key pathological characteristics are:
Gross appearance: Macroscopically, these tumors typically present as white-to-cream-colored, dome-shaped, and well-demarcated masses. [8] Iris and posterior choroidal leiomyomas are predominantly amelanotic, whereas approximately 40% of ciliary body leiomyomas are brown. [1]
Microscopic features:
• Spindle cells exhibiting eosinophilic cytoplasm and cigar-shaped nuclei [3]
• Characteristic paranuclear vacuoles [8]
• An intersecting fascicular pattern without significant cellular atypia [8]
• Low mitotic activity [9]
• Mesectodermal variants may show neural features, including fibrillary cytoplasmic processes [3]
Immunohistochemistry: This is essential for a definitive diagnosis. [10]
• Positive markers: Smooth muscle actin (SMA), desmin, vimentin [3][11]
• Negative markers: S-100, HMB45, SOX10, MelanA (to exclude melanoma)[11]
• Variable expression: Progesterone and androgen receptors (frequently positive) [8]
• Neural markers in mesectodermal type: Neuron-specific enolase (NSE), CD56 [12]
Pathophysiology
The pathophysiology of intraocular leiomyoma involves the proliferation of smooth muscle cells from various ocular structures. The precise pathogenesis of iris leiomyoma remains unclear, although hormonal involvement is speculated due to the tumor’s similarity to uterine leiomyomas (fibroids) and its predilection for females. [6]
These tumors typically exhibit slow growth and produce symptoms via:
• Mass effect, leading to displacement of adjacent structures [9]
• Anterior displacement of the iris-lens diaphragm [9]
• Pupillary distortion or ectopia [6]
• Development of secondary angle-closure glaucoma [13]
• Subluxation of the crystalline lens [7]
• Exudative retinal detachment in cases of choroidal lesions [14]
Primary Prevention
Currently, there are no known preventive measures for intraocular leiomyoma, as the exact causative factors remain elusive. The sporadic nature of these tumors and the absence of identifiable genetic predispositions preclude specific preventive strategies.
Diagnosis
History
Patients typically present with slowly progressive visual symptoms, although some tumors are discovered incidentally during routine ophthalmic examination. [8] The duration of symptoms prior to diagnosis can vary considerably, ranging from months to years. [9]
Common presenting complaints include:
• Progressive blurred vision (the most frequent symptom) [7][14]
• Visual field defects corresponding to the tumor’s location [9]
• Floaters, particularly with tumors in the posterior segment [2]
• Photophobia or glare, especially with iris tumors [6]
• Asymptomatic presentation, with incidental discovery [8]
While most cases have a gradual onset, acute presentations have been documented, such as a mesectodermal leiomyoma of the ciliary body in a 29-year-old female who experienced sudden eyelid swelling and vision reduced to light perception. [13]
Physical Examination
A comprehensive ophthalmic examination is crucial and should encompass:
Visual acuity: This can be variable, depending on the tumor’s location and any associated complications [9].
Intraocular pressure: May be elevated, particularly in cases with angle involvement or secondary glaucoma[13].
Slit-lamp biomicroscopy:
• Iris tumors: Often appear as pink to amelanotic, well-circumscribed masses[11].
• Ciliary body tumors: May induce sectoral lens subluxation or displacement of the iris[7].
• Anterior chamber: Depth can vary; it may be shallow with large ciliary body tumors[13].
Gonioscopy: Essential for evaluating angle involvement and the extent of ciliary body tumors[7].
Dilated fundoscopy:
• Choroidal tumors: Typically appear as dome-shaped, amelanotic to lightly pigmented masses[14].
• An associated exudative retinal detachment may be present[14].
Signs
Clinical signs vary based on the tumor’s location:
Iris leiomyomas:
• Well-circumscribed, typically amelanotic nodules[11]
• May cause corectopia or iris heterochromia [6]
• Localized sector iris thickening can be observed [6]
Ciliary body leiomyomas:
• A dome-shaped mass may be visible through a dilated pupil [7]
• Sectoral zonular weakness leading to lens subluxation [7]
• Anterior rotation of ciliary processes [8]
• Localized episcleral sentinel vessels may be present [13]
Choroidal leiomyomas:
• Amelanotic or lightly pigmented dome-shaped mass [14]
• Orange pigment is typically absent, unlike in melanoma [1]
• May be associated with serous retinal detachment [14]
• Approximately two-thirds of leiomyomas may partially or completely block transillumination, a characteristic also seen in uveal melanoma [1]
Imaging characteristics:
• Low-frequency ultrasound imaging generally reveals low to moderate internal reflectivity. High-frequency anterior uveal ultrasound can be valuable in localizing a leiomyoma to the suprachoroidal space, sometimes demonstrating an overlying layer of intact choroid[1].
• B-scan ultrasonography shows a dome-shaped, acoustically solid mass with low to moderate internal reflectivity[1][8].
• Magnetic Resonance Imaging (MRI) shows variable signal intensity. Positron Emission Tomography (PET) imaging may reveal increased metabolic activity[1][9].
Symptoms
Symptoms are contingent upon the tumor’s size and location:
Visual symptoms:
• Decreased visual acuity (most common) [7][14]
• Metamorphopsia, particularly with choroidal tumors [14]
• Visual field defects [9]
• Monocular diplopia, often due to lens subluxation [7]
Ocular discomfort:
• Foreign body sensation, especially with iris tumors [6]
• Photophobia [6]
• Pain, if secondary glaucoma develops [13]
Acute presentations:
• Sudden vision loss [13]
• Red eye accompanied by elevated intraocular pressure [13]
• Eyelid swelling [13]
Clinical Diagnosis
Diagnosing intraocular leiomyoma clinically is challenging due to its rarity and resemblance to other intraocular tumors, most notably amelanotic melanoma[1][15].
Differential diagnosis includes:
• Amelanotic uveal melanoma (the most critical differential) [1][15]
• Neurofibroma [17]
• Choroidal hemangioma [14]
• Choroidal metastasis [14]
• Adenoma of the ciliary epithelium [7]
Diagnostic challenges: Pigmented uveal leiomyomas can be clinically indistinguishable from melanoma. Consequently, histopathology coupled with immunohistochemical staining for smooth muscle actin is the most reliable method for differentiating pigmented uveal leiomyoma from melanoma[1].
Clinical features suggestive of leiomyoma:
• Younger age at presentation compared to melanoma patients [1][7]
• Female predominance [1]
• Suprachoroidal location as identified on high-frequency ultrasound [1]
• Amelanotic appearance (though this is not exclusively diagnostic) [1]
• Well-circumscribed margins [8]
Definitive diagnosis: Given the clinical similarity to melanoma, a definitive diagnosis necessitates histopathological examination with confirmatory immunohistochemistry [1][10]. It has been suggested that intraocular leiomyomas are rarer than previously reported, with many historical cases being questionable without immunohistochemical verification[10]. Therefore, adherence to strict diagnostic criteria, including immunohistochemical confirmation, is crucial to prevent misdiagnosis[10].
Diagnostic Procedures
The common diagnostic imaging techniques used to identify and evaluate intraocular leiomyomas are transillumination and B-scan ultrasonography. MRI and radionuclide imaging lack sufficient specificity to distinguish leiomyoma from melanoma. Therefore, these techniques should not be prioritized when evaluating suspected intraocular leiomyoma[18][19][20]. Ultimately, while imaging modalities are essential for tumor localization, size assessment, and surgical planning, definitive differentiation between intraocular leiomyoma and uveal melanoma relies on histopathology and immunohistochemistry.
Transillumination
Transillumination is a cost-effective and valid diagnostic procedure that should be coupled with other tools for a proper diagnosis. The tumor's intrinsic physical and chemical characteristics are why direct light can have complete penetration. It demonstrates well-organized cellular arrangement, featuring uniformly aligned cytoplasmic filaments, nuclear palisading, and a relative absence of melanin. This is important to distinguish from other intraocular tumors with more pigment, such as ciliary body melanomas[1]. Melanomas are more likely to cast a shadow during direct illumination, while leiomyomas will most often direct light penetration[15]. This is not absolute. A review done by Tomar et al. revealed that out of 80 patients, only 29 had a positive transillumination test, with some of those patients having partial illumination as well[1].
Ultrasound Imaging
Ultrasound is a primary imaging modality for the evaluation of posterior eye tumors, especially when visualization is limited by media opacities such as dense cataract or vitreous hemorrhage. Ultrasound imaging allows differentiation from other intraocular tumors, such as ciliary body and peripheral choroidal tumors. Ultrasound measures vary depending on the type of tumor.
- Tumor U/S Measurements: The measured basal dimensions of these iris leiomyomas averaged 4.2 ± 2.5 mm (mean ± SD), with a median of 3 mm and a range spanning 1.5 to 9.7 mm. In contrast, ciliary body tumors exhibited a larger average dimension of 12.3 ± 4.8 mm (median: 13.0 mm, range: 2.4–22 mm), while posterior tumors had an average size of 12.0 ± 1.0 mm (median: 12.0 mm, range: 11–13 mm).
Internal reflectivity: A majority of these benign tumors demonstrate low to moderate reflectivity. This pattern of internal reflectivity is similar to choroidal melanoma and posterior uveal melanoma, so it should not be used as a tool for differentiating between leiomyomas and melanomas.
Laboratory Test
Biopsy
Most often, the diagnostic evaluation does not yield a diagnosis that distinguishes leiomyomas from melanomas and other tumors. Fine needle aspiration biopsy (FNAB), the finger iridectomy technique, transscleral biopsy, and enucleation are the various options to collect tumor tissue[21][8]. Anterior uveal tumors involve a transscleral surgical biopsy involves creating a partial-thickness scleral flap or a lamellar scleral pouch[22]. For lesions located behind the equator (posterior), either transvitreal fine-needle aspiration biopsy or a vitrectomy-assisted retinotomy biopsy technique may be utilized for tissue sampling[23].
Histopathology
To differentiate without a doubt, histopathology is necessary. Leiomyomas characteristically demonstrate intersecting fascicles of spindle-shaped cells containing oval nuclei with rounded ends, moderate to abundant eosinophilic fibrillary cytoplasm, and intracellular myoglial fibrils[24]. Of the 80 known cases of intraocular leiomyomas, this presentation is the most consistent but has only been seen in 13 (16.3%). The optimal location for histopathological tissue collection is the space between the sclera and the uveal tract, known as the suprauveal space[24].
Immunohistochemistry
Immunohistochemistry is essential for the accurate diagnosis of intraocular leiomyoma, particularly in distinguishing it from other intraocular tumors such as uveal melanoma. Intraocular leiomyomas can be clinically and radiographically indistinguishable from melanocytic tumors, especially when pigmented, leading to potential misdiagnosis and inappropriate management if based on clinical features alone. Intraocular leiomyomas are classified into two groups based on origin: mesodermal (vascular smooth muscle-derived) and mesectodermal (neural crest-derived, likely from ciliary body muscle)[25]. Immunohistochemistry helps differentiate them: both types express smooth muscle markers (⍺-SMA, MSA, desmin, h-caldesmon) but are negative for melanoma markers (HMB-45, Melan-A). Mesectodermal tumors may also show neural markers (S-100, NSE, CD-56), reflecting their neuroectodermal origin[12][26]. Hormone receptor expression varies: a subset expresses progesterone (25%) or androgen receptors (37.5%), with androgen positivity linked to male cases—suggesting potential sex-specific hormonal influences. Unlike uterine leiomyomas, ocular tumors rarely express estrogen receptors, possibly due to their dual embryologic origins[3][8][27].
Management
Observation
For small, asymptomatic tumors that do not significantly impact vision or cause complications, careful observation with regular follow-up examinations can be an option. This approach involves periodic monitoring using imaging techniques such as ultrasound biomicroscopy and MRI to assess tumor stability and detect any changes that might necessitate intervention[1][7]. Observation for iris and posterior choroidal leiomyoma is not routinely chosen by ophthalmologists due to the ease of surgical excision in the former and strong suspicion of amelanotic melanoma in the latter.
Medical Therapy
Radiation Therapy: Although not commonly used, radiation therapy, such as brachytherapy with ruthenium-106, has been employed as an adjunct to surgical resection in some cases. This approach aims to control tumor growth and preserve vision, particularly when complete surgical excision is challenging[28].
Surgery
1. Transscleral Resection: This is the most common and preferred treatment for anterior uveal leiomyomas, particularly those involving the ciliary body. It involves the surgical removal of the tumor through the sclera. This method has been shown to preserve vision effectively, as demonstrated in a case where a 13-year-old boy underwent transscleral resection with adjuvant ruthenium-106 brachytherapy, resulting in a visual acuity of 20/40 six months post-operation[28].
2. Sector Iridectomy: For leiomyomas located in the iris, sector iridectomy is often employed. This procedure involves the excision of the affected segment of the iris. Immunohistochemical analysis post-excision is crucial for confirming the diagnosis, as seen in a case of primary iris leiomyoma[11]. Iridectomy is preferred over medical management or observation for these tumors located in the iris[29].
3. Enucleation: In cases where the tumor is large, causing significant complications, or when there is a high suspicion of malignancy that cannot be ruled out preoperatively, enucleation may be necessary. This involves the removal of the entire eye, as was the case in a patient with a posterior choroidal leiomyoma initially suspected to be melanoma[30].
4. Sclerouvectomy: This technique is beneficial for managing leiomyomas of the ciliary body and iris. It involves partial lamellar resection of the sclera and uvea, allowing for tumor removal while preserving the globe[7].
Complications
- Secondary Glaucoma: Tumors in the ciliary body or iris can obstruct aqueous humor outflow, leading to increased intraocular pressure and secondary glaucoma[1][11].
- Retinal Detachment: Exudative retinal detachment can occur, particularly with ciliary body leiomyomas, due to the tumor's vascular nature and associated exudation[28].
- Surgical Complications: Surgical interventions, such as transscleral resection or sector iridectomy, carry risks including infection, bleeding, and potential damage to surrounding ocular structures, which can further compromise vision[7][28].
- Tumor Recurrence: Although rare, incomplete surgical excision can lead to tumor recurrence, necessitating further interventions[31].
Prognosis
Leiomyomas are benign tumors that generally do not pose a systemic or life-threatening risk. Prognosis and treatment depend on tumor size and location, with iris leiomyomas offering the most favorable outcomes due to early detection and effective local resection. In contrast, ciliary body leiomyomas often grow slowly but can cause secondary ocular complications and are sometimes mistaken for uveal melanoma, complicating diagnosis and treatment. Posterior uveal leiomyomas are the rarest and often require enucleation due to their association with retinal detachment.[1]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 Tomar AS, Finger PT, Iacob CE. Intraocular leiomyoma: Current concepts. Survey of Ophthalmology. 2020;65(4):421-437. doi:10.1016/j.survophthal.2019.12.008
- ↑ 2.0 2.1 2.2 2.3 Remmer M, Kaliki S, Eagle R, Shields C, Shields J. Giant leiomyoma of the ciliary body. Oman J Ophthalmol. 2014;7(2):81. doi:10.4103/0974-620X.137165
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Koletsa T, Karayannopoulou G, Dereklis D, Vasileiadis I, Papadimitriou CS, Hytiroglou P. Mesectodermal leiomyoma of the ciliary body: Report of a case and review of the literature. Pathology - Research and Practice. 2009;205(2):125-130. doi:10.1016/j.prp.2008.06.004
- ↑ Park SW, Kim HJ, Chin HS, Tae KS, Han JY. Mesectodermal leiomyosarcoma of the ciliary body. AJNR Am J Neuroradiol. 2003;24(9):1765-1768.
- ↑ Nguyen CV, Phung HT, Nguyen QT, Hoang TA. Mesectodermal leiomyoma of the ciliary body: Two Vietnamese case reports. Human Pathology: Case Reports. 2020;20:200381. doi:10.1016/j.ehpc.2020.200381
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Ishigooka H, Yamabe H, Kobashi Y, Nagata M. Iris Leiomyoma: Background, Pathophysiology, Epidemiology. Published online October 29, 2024. Accessed May 27, 2025. https://emedicine.medscape.com/article/1208487-overview
- ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 Biswas J, Kumar SK, Gopal L, Bhende MP. Leiomyoma of the Ciliary Body Extending to the Anterior Chamber. Survey of Ophthalmology. 2000;44(4):336-342. doi:10.1016/S0039-6257(99)00114-9
- ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 Quhill H, Rennie IG, Rundle PA, Mudhar HS. Three cases of intraocular mesectodermal leiomyoma expressing progesterone and androgen receptors. Eye. 2013;27(5):669-672. doi:10.1038/eye.2013.37
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Plesníková P, Jurenová D, Lysková D, Furdová A, Valášková J, Babál P. Ciliary Body Leiomyoma. Case Rep Ophthalmol. 2022;13(1):259-264. doi:10.1159/000523716
- ↑ 10.0 10.1 10.2 10.3 Foss AJE, Pecorella I, Alexander RA, Hungerford JL, Garner A. Are Most Intraocular “Leiomyomas” Really Melanocytic Lesions? Ophthalmology. 1994;101(5):919-924. doi:10.1016/S0161-6420(13)31239-1
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 Yeaney GA, Platt S, Singh AD. Primary iris leiomyoma. Survey of Ophthalmology. 2017;62(3):366-370. doi:10.1016/j.survophthal.2016.11.007
- ↑ 12.0 12.1 Odashiro AN, Fernandes BF, Al-Kandari A, Gregoire FJ, Burnier MN. Report of Two Cases of Ciliary Body Mesectodermal Leiomyoma. Ophthalmology. 2007;114(1):157-161. doi:10.1016/j.ophtha.2006.07.023
- ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 Kim JM, Hall LB, Elia M, Ehrlich MS, Materin MA, Sinard JH. Acute Presentation of Mesectodermal Leiomyoma of the Ciliary Body. Ocul Oncol Pathol. 2017;3(4):304-309. doi:10.1159/000464466
- ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 Zhou N, Wei W, Xu X. Pathology features and the results of treatment of two cases of posterior choroidal leiomyoma. BMC Ophthalmol. 2020;20(1):198. doi:10.1186/s12886-020-01445-6
- ↑ 15.0 15.1 15.2 15.3 Shields JA. Observations on Seven Cases of Intraocular Leiomyoma: The 1993 Byron Demorest Lecture. Arch Ophthalmol. 1994;112(4):521. doi:10.1001/archopht.1994.01090160097028
- ↑ Yu Y, Cheng Y, Wang K, Sun K, Shen D, Liang J. Intraocular schwannoma: A case series of 3 patients. Oncol Lett. Published online November 16, 2018. doi:10.3892/ol.2018.9718
- ↑ Matsuo T, Notohara K. Choroidal Schwannoma: Immunohistochemical and Electron-Microscopic Study. Ophthalmologica. 2000;214(2):156-160. doi:10.1159/000027488
- ↑ Oh KJ, Kwon BJ, Han MH, et al. MR imaging findings of uveal leiomyoma: three cases. AJNR Am J Neuroradiol. 2005;26(1):100e3
- ↑ Brown WC, Kellenberger RE, Hudson KE, Matthews JL.Leiomyoma of the iris: report of a case. Am J Ophthalmol.1957;43(3):457e60
- ↑ Dunbar JC. Leiomyoma of the ciliary body; report of a case exhibiting a significant uptake of radioactive phosphorus. Am J Ophthalmol. 1956;42(2):204e7
- ↑ Kiratli H, Agın A, Önder S. Ciliary body mesectodermal leiomyoma diagnosed by fine needle aspiration biopsy. OculOncol Pathol. 2017;3(3):199e203
- ↑ Correˆa ZM, Augsburger JJ. Indications for fine needle aspiration biopsy of posterior segment intraocular tumors. Am J Ophthalmol. 2019;207:45e61
- ↑ Fastenberg DM, Finger PT, Chess Q, Koizumi JH, Packer S. Vitrectomy retinotomy aspiration biopsy of choroidal tumors. Am J Ophthalmol. 1990;110(4):361e5
- ↑ 24.0 24.1 Blodi FC. Leiomyoma of the ciliary body. Am J Ophthalmol. 1950;33(6):939e42
- ↑ Jakobiec FA, Font RL, Tso MO, Zimmerman LE. Mesectodermal leiomyoma of the ciliary body: a tumor of presumed neural crest origin. Cancer. 1977;39(5):2102e13
- ↑ Yu DY, Cohen SB, Peyman G, Tso MO. Mesectodermal leiomyoma of the ciliary body: new evidence for neural crest origin. J Pediatr Ophthalmol Strabismus. 1990;27(6):317e21
- ↑ Alenda C, Aranda FI, Paya´ A, Co´ rdoba C. Mesectodermal leiomyoma of ciliary body. Int J Surg Pathol. 2002;10(4):309e12
- ↑ 28.0 28.1 28.2 28.3 Richter MN, Bechrakis NE, Stoltenburg-Didinger G, Foerster MH. Transscleral resection of a ciliary body leiomyoma in a child: case report and review of the literature. Graefes Arch Clin Exp Ophthalmol. 2003;241(11):953-957. doi:10.1007/s00417-003-0766-x
- ↑ Erdbrink WL, Harbert F. Leiomyoma of the iris; report of a case and review of literature. AMA Arch Ophthalmol. 1955;53(5):643e8
- ↑ Chiang WY, Lin JW, Yang IH, Kuo HK. Posterior choroidal leiomyoma: a rare case report and literature review. APMIS. 2015;123(6):540-545. doi:10.1111/apm.12384
- ↑ Arat YO, Font RL, Chaudhry IA, Boniuk M. Leiomyoma of the orbit and periocular region: a clinicopathologic study of four cases. Ophthalmic Plast Reconstr Surg. 2005;21(1):16-22. doi:10.1097/01.iop.0000150426.79781.54
