Orbital Tumors

Orbital tumors are abnormal growths of tissue. They can be benign, as in most cases, or malignant. The orbit is a cavity formed by bones that house the eye, the muscles that move the eye, the optic nerve and the fat that fills the space between all these structures. A tumor can appear in any of these tissues.

ORBITAL TUMORS IN CHILDREN

In children, most tumors are the result of a developmental problem. The most common benign tumors in children are dermoid cysts and capillary hemangiomas, the latter a benign tumor formed by small blood vessels. Children also commonly suffer from orbital cellulitis, a condition that begins with severe sinusitis and can then invade the orbit, causing the eyeball to bulge forward. This is not a tumor but can lead to protrusion of the eye. Malignant tumors in children are very rare, but a rapidly growing mass is a source of concern that should be studied promptly.

ORBITAL TUMORS IN ADULTS

In adults, the most common benign tumors originate from blood vessels: hemangiomas, lymphangiomas and arteriovenous malformations. Tumors of the nerves, or schwannomas, of the fat, or lipomas, and of the paranasal sinuses, or mucoceles, are less frequent.

Often, pain in the eyes or prominence of the eyes may be mistakenly attributed to an ocular tumor. However, after proper evaluation it is often diagnosed as a non-infectious inflammation called orbital pseudotumor, as it is commonly mistaken for a tumor.

Occasionally, this inflammation may be the result of a general condition such as Graves’ disease, which affects the thyroid gland.

The most common malignant tumors in the orbits are lymphomas, most of which are located only in the orbits, do not endanger the rest of the body and have a high likelihood of being cured.

Metastases from distant tumors can appear in the orbit, the most frequent ones being breast and prostate tumors. Direct invasion of the skin surrounding the orbit and paranasal sinuses can occur with basal cell carcinomas and spinocellular carcinomas. Other malignant tumors, such as hemangiopericytomas, chondrosarcomas and malignant neurofibromas occur rarely.

How does a tumor present?

Symptoms that may occur are decreased vision, protrusion of the eye, double vision, drooping of the eyelid or pain.

How are orbital tumors treated?

Treatment varies from case to case. Thus, medication, radiation or surgery may be prescribed. Surgery for orbital tumors, when performed by ophthalmologists specialized in orbital surgery, is very safe. We have published a scientific paper in the Ophthalmology journal, in the United States, where we evaluated the visual outcome after the removal of tumors larger than the eye. In this paper we proved that even tumors of this size can be removed with little risk.

How do you know if a tumor is benign or malignant?

Imaging studies (CT scan and MRI) make it possible to locate the tumor accurately and see its characteristics. Together with the age and form of presentation, they allow us to predict the most probable type of tumor.

However, the only way to know with certainty the exact type of tumor and whether it is benign or malignant is the analysis by the pathologist, after complete or partial surgical removal.

BEFORE AND AFTER

case 1

BEFORE:

Patient with benign congenital cystic tumor, which grew throughout childhood (dermoid cyst).

Surgery:

The tumor was removed intact through an incision in the eyelid crease to avoid a visible scar, and pathological analysis confirmed the diagnosis.

after:

1 day after surgery, the patient returned to her home country.

case 2

BEFORE:

tomography:

This patient presented with an orbital tumor in a difficult position, very deep in the orbit and causing deviation of the optic nerve. His visual field was deteriorating, so surgical removal was recommended.

Immediately after:

Despite careful dissection under microscope, the removal of the tumor resulted in altered outward eye movement (abduction).

after:

Over the course of the following weeks, the patient fully recovered movement and his visual check-ups were normal. This case shows the extreme difficulty of some orbital tumors.

case 3

BEFORE:

tomography:

This patient had a tumor behind her left eye, with progressive vision loss.

surgery:

The tumor was extracted completely through an internal incision on the eyelid, to avoid a visible scar. This can be achieved, depending on the location of the tumor.

Immediately after:

The next day the patient was pain free.

after:

Results after 6 months.