#16. Tumours of the orbit. Parasitic orbital diseases.

Question 1

What are the TYPES of ORBIT TUMOURS?

Answer 1

1) PRIMARY Orbit Tumours

2) SECONDARY Orbit Tumours

3) METASTATIC Orbit Tumours

Question 2

What are the CLASSIFICATIONS of ORBIT TUMOURS?

Answer 2

1) PRIMARY Orbit Tumours

2) SECONDARY Orbit Tumours

3) METASTATIC Orbit Tumours

Question 3

What are PRIMARY Orbit Tumours?

Answer 3

• ARISE from VARIOUS ORBITAL Structures

a. Haemangiomas
b. Adipose Tissue Tumours = Liposarcoma
c. Fibrous Tissue Tumours = Fibroma

Question 4

What are SECONDARY Orbit Tumours?

Answer 4

a. Eyeball Tumour = Retinoblastoma

b. Eyelid Tumour = Squamous / Basal Cell Carcinoma

c. Cranial Cavity Tumour = Glioma / Meningioma (INVADES Orbit)

Question 5

What are METASTATIC Orbit Tumours?

Answer 5

a. NEUROblastoma = Adrenal / Sympathetic Chain

b. NEPHROBlastoma = Kidneys

c. Carcinoma = Lungs / Breast / Prostate / Thyroid / Rectum

d. Malignant Melanoma = Skin

e . EWINGS Sarcoma = Bones

Question 6

Give 6 Examples of ORBIT TUMOURS

Answer 6

1) CAPILLARY HEMANGIOMA

2) CAVERNOUS HEMANGIOMA

3) ORBITAL VARICES

4) RHABDOMYOSARCOMA

5) NEURAL TUMOURS

6) DERMOID CYST

Question 7

Describe CAPILLARY HEMANGIOMA as an ORBITAL TUMOUR

Answer 7

• Occurs in INFANTS with ANTERIOR ORBITAL Swelling
• With INCREASED Features along with CRYING
• EYELID Skin Lesion = STRAWBERRY NAEVUS
• TREATMENT = Steroids Injected into Lesion
• INDICATIONS
  a. Optic Nerve Compression
  b. Ocular Dysfunction
  c. Exposure Keratitis

** Tumour OFTEN DISAPPEAR SPONTANEOUSLY

Question 8

Describe CAVERNOUS HEMANGIOMA as an ORBITAL TUMOUR

Answer 8

• BENIGN Orbital Tumour (Adults)
• Occurs in YOUNG Adults
• With PAINLESS Axial Proptosis of GRADUAL Onset
• TREATMENT = Surgical EXCISION

Question 9

Describe ORBTIAL VARICES as an ORBITAL TUMOUR

Answer 9

• DILATED Orbital VEINS
• INTERMITTENT; UNILATERAL (1 eye) NON-Pulsatile Proptosis
• VISIBLE LESIONS on Eyelids OR Conjunctiva
• ACUTE Orbital HAEMORRHAGE / THROMBOSIS
• TREATMENT = Surgical EXCISION

Question 10

Describe RHABDOMYOSARCOMA as an ORBITAL TUMOUR

Answer 10

• VERY RARE, but…AGGRESSIVE!
• Onset at 7 y/o
• RAPIDLY PROGRESSIVE Proptosis
• Palpable Mass
• ARISES from EXTRAOCULAR Muscles
• TREATMENT = INCISIONAL Biopsy –> RADIOTHERAPY / CHEMOTHERAPY

Question 11

Describe NEURAL TUMOURS as an ORBITAL TUMOUR

Answer 11

a) OPTIC NERVE GLIOMA!

• Presents in CHILDHOOD
• SLOWLY PROGRESSIVE Proptosis
• Visual Loss
• SWOLLEN / PALE Optic Disc
• 25 - 50% have NEUROFIBROMATOSIS-1

b) OPTIC NERVE SHEATH MENINGIOMA

• Affects MIDDLE-AGED FEMALES
• SLOWLY PROGRESSIVE Proptosis
• Visual Loss
• Optic Disc shows OPTICOCILIARY SHUNT Vessels

TREATMENT = Surgery AND Radiotherapy

Question 12

Describe DERMOID CYST as an ORBITAL TUMOUR

Answer 12

• Proptosis
• Occurs at ANY Age
• Palpable mass, depending on SITE / SIZE
• ARISE from Embryonic DISPLACEMENT of EPIDERMIS to a SUBCUTANEOUS Location

2 TYPES
a. Simple Dermoid (Infants)
b. Complicated Dermoid (Adolescence)

TREATMENT = COMPLETE Surgical EXCISION

Question 13

What are the 5 PARASITIC ORBITAL DISEASES?

Answer 13

1) Trichinellosis = Trichinella Spiralis

2) Onchocercosis = Onchocerca Volvulus

3) Filariasis = Dirofilaria Repens

4) Loa Loa

5) Echinococcosis