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Orbital Tumour: Here's Everything You Need To Know About This Eye Disease

Orbital Tumour: Here's Everything You Need To Know About This Eye Disease
Know All About Orbital Tumour

An orbital tumour is a tumour that develops in the 'orbit,' the bony socket in the front of the skull that houses the eye. Read on to know all about this eye disorder.

Written by Editorial Team |Updated : June 23, 2021 8:31 PM IST

Tumours and inflammations can occur behind and around the eye. An orbital tumour refers to a tumour positioned in the 'orbit', which is the bony socket in the front of the skull that comprises the eye. Even a minuscule tumour in this small, crowded region can cause significant symptoms and functional effects. Eyes bulge forward and cause serious vision problems when the tumours are large. Orbital tumours are both benign and, malignant in nature.

Among children, this tumour may be apparent at birth or acquired later. Although most orbital tumours are benign, malignancies such as retinoblastoma and rhabdomyosarcoma are vision- and life-threatening. In adults majority of orbital tumours include cysts, vascular lesions (arising from blood vessels), lymphomas, neurogenic tumours (arising from nerves), and secondary tumours (either metastatic or spread directly from the surrounding sinuses or cranium).

The eyes and the structures around them (orbit) is the second most complex organ only next to the brain. Any abnormal growth of this tissue either solid or cystic present a spectrum of signs and symptoms depending on the age of the patient and the biological nature of the tumour.

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Signs & Symptoms Of Orbital Tumours

  • Bulging of the eye
  • Double vision
  • Loss of vision
  • Droopy or swollen eyelid
  • Feeling of pressure in the eye
  • Flattened eyeball
  • Pain and inflammation

On occasions, this tumour is incidentally detected while imaging of the head for other conditions and patient may develop their symptoms over time. The rapidity of onset and the location and nature of their symptoms are often important clues to determine whether a problem is benign or cancerous. As the eyes are pushed forward, the eyelids often appear to be retracted from it hence patients develop bulging of the eye (proptosis or exophthalmos), and as larger tumours displace the axis of the eye, patients may see double vision. Some tumours can actually be seen or felt on examination. Those tumours arising from the optic nerve present with progressive diminution of vision. It is therefore important to identify ocular and orbital tumours early.

Diagnosis Of Orbital Tumours

Determining orbital tumours can be done by using advanced diagnostic procedures and technology to efficiently diagnose, carefully observe the condition. Diagnostic procedures include:

Biopsy: A sample of the tissue is removed by a small incision by an expert physician, this tissue is used to examine the type of tumour present.

Computerized tomography (CT) scans: X-rays and computers are used in the test to create images of the tumour to detect its location, size and various other abnormalities.

Magnetic resonance imaging (MRI): This particular test uses a powerful magnet and radio waves to create images of the tumour to see its size and location, and to rule out other deformities.

Though Imaging studies have rapidly evolved in the last few decades ultrasonographic examination of the orbit is still helpful in the evaluation of cystic lesions and angiography is still the imaging modality of choice for vascular lesions, such as arteriovenous malformations and low-flow arteriovenous fistulas and Cerebral angiography should be undertaken in any patient with pulsatile exophthalmos. Magnetic resonance imaging gives high-resolution images of the standard components of the orbit and nonosseous lesions in three dimensions. In cases of osseous lesions, CT is the modality of choice, either alone or in combination with MR imaging.

Treatment

In the early stages significant percentage of these tumours are treated by the ophthalmologist alone, but in view of its complex anatomical entity, management of orbital tumours poses a challenging surgical task, needing proficiency with a multitude of approaches, hence it is desirable to deal with these tumours by a multidisciplinary team approach, undertaken by the well-experienced neurosurgical team along with oculoplastic surgeon for tumours involving the orbital cranial junction and the superior orbital compartment to facilitate optimal removal of the tumour and skull base sealing as well as good cosmetic results. And the involvement of a radiation oncologist in the team for adjuvant radiotherapy/chemotherapy would be beneficial for prolonged recurrence-free and better quality of life. However, not all tumours require surgical excision and in some, radiation, chemotherapy, or immunotherapy may be the indicated form of treatment.

(this article is contributed by Dr. Amaresh S Bhaganagare, Consultant Neurosurgeon, HCG Cancer Hospital Bengaluru)