There is a long list of orbital masses to consider. In this case, there are a few clues that can help make the diagnosis of orbital venous varices:

• typical position in the superior aspect of the orbit, appearing contiguous with the superior ophthalmic vein
• MRI signal intensity follows that of the cavernous sinus
• left inferior orbital mass is not seen on the CT ("deflated") but is present on the MRI

The "gold standard" test is a CT orbits without contrast or breath-hold followed by a contrast-enhanced scan with Valsalva, looking for a change in size between these two acquisitions.