TUMORS OF THE ORBIT by Dr.

Jonathan del Prado 082708

ANATOMY - Removal of the entire globe
Orbit and orbital contents.
- Bony cavities that contain:
Globe ORBITAL TUMORS
Extraocula - Primary or secondary congenital
r muscles or acquired lesion that forms a
Nerves discernible mass in the orbit.
Fat - Excluded are manifestations of
Blood systemic disease, inflammatory,
vessels and traumatic lesions.
- 4 walls: the roof, lateral wall, - Signs:
medial wall, and the floor. Displacement of the globe
- Apertures: superior orbital Pulsating proptosis
fissure, inferior orbital fissure, - CT scan is the rule.
optic canal.
- Adjacent sinuses: frontal, PRIMARY TUMORS
ethmoid, maxillary, and sphenoid 1. Meningocele,
sinuses. meningoencephalocele, and
- Pear-shaped with the optic nerve encephalocele.
as the stem. 2. Hemartoma (tissue proliferation
- Medial walls are parallel. normally at site)
- Average volume of an adult Capillary Hemangioma
orbit: 30cc Neurofibroma
- 7 bones make up the orbit: 3. Choristoma (tissue proliferation
Frontal, zygomatic, maxillary, not at normal site)
ethmoid, sphenoid, lacrimal, Dermoid Tumor
palatine.
Eyelid ACQUIRED TUMORS
- Skin: thinnest of the body. a. Lacrimal Gland Tumors
- Margin: contains the punctum, b. Others
the grey line, and the eyelashes.
- SQ tissue Meningocele, meningoencephalocele,
- Orbicularis oculi muscle and encephalocele
- Continuous with the brain
ORBIT SURGERIES and/or meninges through a
a. Evisceration defect in the bones.
- Removal of the intraocular - An encephalocele most
contents leaving a scleral commonly presents as an
shell. anterior protrusion between the
b. Enucleation nose and the eyebrow or as a
- Removal of the entire globe. lateral protrusion into the orbit.
c. Exenteration

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 Faster growth
Capillary Hemangioma More painful
- Most common tumor in Irregular edges with bony
childhood. destruction
Periocular swelling - Treatment: radical surgery
Proptosis and radiography.
- Increases in size during crying
and straining. Cavernous Hemangioma
- Grows during the 1st year of life - Occurs in adults.
then involutes spontaneously. - Occurs anywhere in the orbit.
- Benign tumor which is
Dermoid Cyst encapsulated and usually within
- Most common primary orbital the muscle cone.
tumor in childhood. - Slowly progressive unilateral
- Entrapment of epithelial proptosis.
structures at the site of closure - Treatment: surgical excision.
of fetal tissue.
- Most are cystic. Lymphoma
- Commonly found anterior to the - Most orbital lymphomas are
orbital septum along the upper non-Hodgkins type and tend to
margin of the orbital rim. present in the 6th and 7th
decades.
Lacrimal Gland Tumors - Located superiorly and anteriorly
a. Benign Mixed Tumor in the orbit.
- Pleomorphic lacrimal gland - Present over several months
adenoma. with gradual painless proptosis
- In adult life. of 5mm or less.
Painless - CT scan accurately demonstrates
Smooth the molding of the mass to the
Firm orbital structures.
Nontender - Only biopsy can provide the
- Slowly progressive swelling definitive diagnosis.
in the upper outer quadrant
of more than a years Leukemia
duration. - Known to infiltrate the eye in
- Treatment: surgical excision. 80% of cases but rarely presents
b. Malignant Lacrimal Gland Tumor in the orbit.
- Consist of adenoid cystic - The acute myelogenous
carcinoma, pleomorphic leukemias are more likely to
adenocarcinoma (malignant involve the orbit.
mixed tumor), primary
adenocarcinoma,
mucoepidermoid carcinoma,
and squamous carcinoma.

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SECONDARY TUMORS AND METASTASES - Destruction of sinus ostia
From the skin: because of recurrent
1. Basal Cell Carcinoma inflammation, trauma, or
2. Squamous Cell Carcinoma intrinsic mucosal disease.
3. Sebaceous Carcinoma - Expand slowly to involve the
From the sinus: orbital cavity.
1. Mucocele - Most commonly involved
From the eye: sinuses: Frontal and Ethmoid.
1. Retinoblastoma
Retinoblastoma
* Common orbital metastases in adults - Most common intraocular tumor
is breast Ca in women and lung CA in of childhood.
men. - 1 in 15,000 to 1 in 34,000 births.
- Affects all races, 5-10% inherited.
Basal Cell Carcinoma - Both sexes affected equally.
- Most common malignant eyelid - No predilection for R or L eye.
tumor. (90% of cases) - Average age of diagnosis:
- Usually in the lower eyelid. 18months, rare after 4y.o.
- Can present as a firm, - Careful ophthalmoscopy should
translucent, raised nodule or can be performed in all children.
be ulcerated. - Highly malignant neoplasm that
Slow growing grows relentlessly.
Locally invasive - Almost always has a fatal
Non metastasizing outcome if untreated.
- Tumor arises from retinal cells
Squamous Cell Carcinoma and initially confined to the
- Much less common but more retina.
aggressive. - Common avenue for extraocular
- Metastases to regional lymph extension: optic nerve.
nodes. - Prognosis is excellent if treated
- Usually in lower eyelid. in its early stages.
- Hard nodule or a roughened Leukocoria (classic clinical sign)
scaly patch. Strabismus or ocular
misalignment (1/3 of cases)
Sebaceous Gland Carcinoma - Treatment options:
- Rare tumor found in the elderly. a. Enucleation
- Arises from the eyelid glands. b. Chemoreduction
- High mortality rate due to delay c. External beam irradiation
in diagnosis. d. Scleral plaque irradiation
- May resemble a chalazion or e. Photocoagulation
conjunctivitis initially. f. Cryotherapy
g. Thermotherapy
h. chemotherapy
Mucocele

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