Monday, 28 July 2014

Experiences with orbital tumours


       Experiences with orbital tumours

A total of 104 cases of orbital tumours were seen during the last 20 years. Orbital tumours comprise an insignificant percentage of total admissions in hospital appearance. In this group forty eight were benign, 22 primary malignant and three metastatic orbi­tal growths.

Twentysix orbital tumours had extended from adjoining paranasal sinuses and five from middle cranial fossa and will not be further discussed in this study as further treatment was carried out by E.N.T. and neurosurgical departments respectively.

Malignant tumours of lacrimal gland can be seen at any age. A case of lacrimal gland carcinoma was seen in 12 year old child. One mixed tumour of lacrimal gland was seen spreading profusely in the floor of orbit. Hydatid cyst of orbit presented as an acute tumour in a female aged 25 years. 

In one young adult patient after shelling out a large neurelimomma and in another 5 years old child excision of an optic nerve glioma by lateral orbitotomy caused anaes­thesia of the cornea which remained a major post operative problem.


Orbital tumours in children have some distinctive features as compared to adults and almost 40% tumours in this series were from patients below 15 years of age. There is a high incidence of neurogenic tumours, haem­angiomas and congenital defects. In malig­nant condition the commonly encountered tumours are rhabdomyosarcoma and other lymphomas.

Treatment of orbital tumours again is rather very complex. In general while almost all the benign lessions can be dealt by surgery, unfortunately there are very few primary malignant conditions where surgery is helpful except for diagnostic biopsy or destructive operation of exenteration which may particu­larly be indicated in all lacrimal gland carcinomas.

Great deal of progress has been made in treatment of malignant conditions by deep X-ray therapy (or cobalt therapy) although complete cure is rarely obtained in any malig­nant tumour of the orbit by radiotherapy. Many tumours may show almost a complete temporary remission as those associated with leukaemias, other lymphomas, lymphosar­comas. One tumour completely curable is

haemangioma of lids by low voltage deep X-ray therapy.

Radio isotope scanning by Techneticum 99, Radioactive iodine given i.v. and scanning done after some minutes or hours may help in localising tumour at sphenoidal ridge or a unilateral retrobulbar tumour when routine skiagram only reveals a dense soft tissue shadow. C A T scanning may help in elimi­nating intracranial conditions.

In twelve cases where the tumours were considered not accessible by direct approach, lateral orbitotomy was done (by the Senior author in each case) and tumours successfully removed. The youngest child was only I years old with an undifferentiated benign neurogenic tumour and growth was comple­tely removed. One encapsulated haemen­gioma was removed which had assumed big size causing extreme degree of proptosis. In one case after lateral orbitotomy, no tumour mass could be isolated and histology of biopsy material showed only a chronic granu­loma. The patient had remission of propto­sis in due course of time.

Lateral orbitotomy should not be done in conditions where malignancy is suspected as it will accelerate the spread of the tumour further.


One hundred and four cases of orbital tumours were seen out of which 48 were benign, 22 malignant. 3 metastatic and the rest had spread from paranasal sinuses or cranial fossa. Their presenting features are discussed.


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