COMMON ORBITAL TUMORS
Cavernous Hemangioma
Background Information
Cavernous hemangioma is the most common benign intraorbital (inside the eye socket) tumor and is most often diagnosed in middle-aged adults. Although these tumors can be found anywhere inside the eye socket, they are most commonly found right behind the eye in the muscle cone, resulting in proptosis (bulging of the affected eye).
Symptoms
Cavernous hemangioma patients most commonly present with slowly-progressing proptosis of the affected eye with no compromise in visual function. Vision can be affected as a result of compression caused by the optic nerve or they eye.
Signs
The most common sign is stable or slowly progressing proptosis of the eye without signs of invasion into the muscles that move the eye.
Computer tomography (CT) scans and/or MRI are often used as diagnostic tools in evaluation and diagnosis of cavernous hemangioma.
Due to the slow-growing nature of cavernous hemangiomas, these tumors are kept under observation for growth. Tumor growth is measured by assessing such factors as visual acuity, color vision, proptosis (bulging of the affected eye), strabismus (double vision), and visual fields.
Treatments
Decision for treatment of cavernous hemangioma is made on an individualized basis. Due to that fact that cavernous hemangiomas are typically slow-growing, these tumors are usually kept under observation for growth prior to consideration of other therapies. If compression of the optic nerve or eye, significant growth or dramatic proptosis is encountered, the tumor may be completely removed through surgical excision.
What to Expect
Fortunately, cavernous hemangiomas are benign and therefore do not spread to other parts of your body.
Dermoid Cyst
Background Information
Dermoid cysts account for up to 5% of all orbital tumors, accounting for the most common type of orbital cyst. These tumors are choristomas, containing normal tissues found in abnormal locations, and most commonly present in infancy. Deeper cysts may present later in life, often during an individual’s thirties or forties.
Symptoms
Dermoid cysts are usually smooth, firm, not tender, and often less than two centimeters in diameter. Typically patients experience either slow and progressive growth of the cyst or the cyst can stay stable in size. If the cysts are damaged through trauma, swelling, redness, and discomfort due to leakage of lipid and keratin from the ruptured cyst can occur.
Signs
Computer tomography (CT) and/or MRI scans are often used as diagnostic tools in the evaluation of dermoid cysts.
Treatments
Decision for treatment of dermoid cysts is made on an individualized basis. Most of these benign tumors are completely removed via surgical excision in order to prevent traumatic rupture of the cyst. Surgical excision is achieved through lateral, anterior, or anterolateral orbitotomies, depending on the size and location of the tumor within the orbit.
What to Expect
Fortunately, dermoid cysts are classified as benign tumors and therefore they do not spread to other parts of the body. Recurrence after excision is rare. If a cyst has ruptured prior to excision, then the recurrence rates are slightly higher.
Sphenoid Wing Meningioma
Background Information
Meningiomas, in general, constitute about twenty percent of all adult and two percent of all pediatric intracranial tumors. They may arise in any location containing meninges (series of membranes encasing the central nervous system). Sphenoid wing meningioma, in particular, forms behind the eye on the skull base. It can often involve the orbit (eye socket) in addition to the brain cavity. The average age of diagnosis for these tumors in adults is 50 years old, with incidence increasing with age from this point on.
Symptoms
Sphenoid wing meningioma patients most commonly present with slight bulging of the temple and slowly-progressing proptosis (bulging of the affected eye). Other symptoms may include anosmia (inability to perceive odor), visual compromise, mental changes, headache, and other symptoms of increased intracranial pressure.
Signs
Computer tomography (CT) scans and magnetic resonance imaging (MRI) are often used as diagnostic tools in evaluation of sphenoid wing meningioma, allowing for definitive diagnosis.
Treatments
Decision for treatment of sphenoid wing meningioma is made on a case-by-case basis. When deemed necessary, sphenoid wing meningioma is most commonly treated with surgical removal of the tumor, which may be followed with radiation therapy.
What to Expect
Prognosis of sphenoid wing meningioma depends on tumor size and degree of infiltration. Fortunately, most meningiomas are ‘benign’ and therefore fairly slow growing, with true metastasis (spread of the tumor to other parts of the body) being fairly rare.
Ocular Lymphoma
Background Information
Lymphoma is a name that encompasses many different types of cancer each with its own behaviour pattern. Orbital lymphomas are a type of non-Hodgkin lymphoma that occurs in or near the eye. These tumors can be subdivided into two categories: intraocular lymphoma and orbital (eye socket) lymphoma. Intraocular lymphomas occur inside of the eye and are typically thought of as a part of CNS (brain) lymphoma; while orbital lymphomas occur outside of the eye but are closely associated with it. CNS/intra-ocular lymphoma are most commonly comprised of large B-cells, where orbital lymphoma is most commonly of the MALT subtype.
Symptoms
Intraocular lymphoma patients often present with painless decreased vision, uveitis (inflammation of the uvea, the pigmented vascular middle layer of the eye), photophobia, and floaters. In contrast, orbital lymphomas often present with a mass around or behind the eye. When symptoms of orbital lymphomas do exist, they may include proptosis (bulging of the affected eye), pain, diplopia (double vision), and decreased vision.
Signs
An important diagnostic evaluation for orbital lymphoma is biopsy. This method of evaluation allows for histopathologic examination of the suspected tumor and serves as a confirmation method for diagnosis. In addition, computer tomography (CT) scans and magnetic resonance imaging (MRI) are often used as diagnostic tools in evaluation of ocular adnexal lymphoma, allowing for definitive diagnosis. Evaluation of involvement in other parts of the body is always performed to fully evaluate the extent of disease.
Treatments
When deemed necessary, orbital lymphomas are most commonly treated with radiation therapy, chemotherapy.
What to Expect
Prognosis of orbital lymphomas depends on the type of lymphoma, tumor size, extent of disease at the time of presentation.