Tumors

The orbit as any other region of the human body is home to a large number of tumours, either benign (most common) or malignant.

Benign tumours involving the orbit, due to it not being an expandable cavity, can behave as malignant lesions resulting in compression of the optic nerve or the eyeball.

Where do orbital tumours originate?

They can appear anywhere: from the bone tissue itself to orbital tissues localized in the lacrimal gland, anterior orbit or eyeball. They can be found just behind the eyeball (intraconical) or outside the muscles (extraconical).

Depending on location they will behave in a more or less aggressive manner affecting the eye.

There are also types of orbital inflammation that can behave like tumours. They are difficult to label and treat, given the wide variety of types of inflammation that can occur in the orbit.

CT scan evidencing intraconically growing hemangioma

The nature of these tumours is varied:

- Benign tumours:

- Vascular lesions: hemangiomas (the most common)

- Cystic lesions: dermoid cysts

- Meningiomas and gliomas of the optic nerve

- Malignant tumours

- Lymphomas: very common in the lacrimal gland

- Rhabdomyosarcomas

- Adenocarcinomas

- Metastasis

- Tumours of neighbouring structures such as sinuses

What symptoms may occur?

The predominant symptom of all orbital tumours is displacement of the eyeball.

Proptosis and inferior displacement of right eye orbital tumour

Sometimes also the sensation of pressure or pulsatile character can be felt.

Other times they may begin acutely as pain and disorders of the eye muscles with double vision.

In some lesions such as carotid cavernous fistulas a beat near the orbit may be evidenced.

Carotid cavernous fistula with very thick vessels

More rarely they begin with vision loss, compressive visual field loss being the most frequent symptom in these cases.

Whenever proptosis (anterior displacement of the eyeball) is diagnosed, radiologic studies should be performed such as MRI or CT scans to determine what type of lesion is causing it.

How are they treated?

It depends on their nature and location within the orbit.

Lymphoid tumours are treated with systemic chemotherapy

Malignant tumours should be resected completely, sometimes leading to loss of the eyeball and the entire orbit, in a procedure known as exenteration.

Radiation therapy is used in some tumours as adjuvant treatment.

Benign tumours are treated depending on their size and location. Treatment for small vascular tumors may consist in watchful waiting.

Sometimes they are operated through openings to enable orbital tumour removal. This type of surgery is performed as delicate microsurgery.

The gateway to the orbit will be through natural folds of the eyelids or through the conjunctiva.

Superior nasal quadrant orbital tumour. Anterior approach

This is a highly complex surgery that requires two or three surgeons, in order not to injure the most delicate orbital and ocular structures.

Lymphoid tumour involving the lateral rectus muscle

Lymphoid tumour involving the lateral rectus muscle. Before and after chemotherapy

Surgery is performed under general anesthesia. The patient is admitted for a period of 2-3 days, monitoring the existence of bruises and evaluating vision at all times.

The possibility exists that some tumours may recur.

The specialist will assess the possibility of intervention according to the risk of complications, location, type and age of the patient.