By Paul T. Finger, MD
Tumors and inflammations can occur behind and around the eye. They can push the eye forward causing a bulging of the eye called proptosis (image). Alternatively, if the bulging does not allow the eye lids to close, orbital tumor proptosis can cause corneal breakdown. The most common causes of proptosis are thyroid eye disease and lymphoid tumors (lymphoma and atypical lymphoid hyperplasia).
Other tumors include vascular tumors (e.g. hemangiomas, lymphangioma, hemangiopericytoma), lacrimal gland tumors (e.g. dacryoadenitis, benign mixed tumor, sarcoidosis and adenoid cystic carcinoma), and growths that extend from the sinuses into the orbit (e.g. squamous carcinoma, mucocele). Metastatic cancer can come from other parts of the body to form an orbital tumor. Lastly, an orbit tumor can also be caused by inflammation (e.g. pseudotumor, sarcoidosis) or infection (abscess).
Most patients with orbital tumors notice a bulging of the eyeball or double vision (diplopia). Infections, inflammations and certain orbital cancers can cause pain. Less commonly, orbital tumors are accidentally discovered when patients have a CT or MRI of the head, sinuses and orbit.
Though CT, MRI’s and ultrasound can help in determining the probable “clinical” diagnosis, most orbital tumors are diagnosed by a surgical biopsy called an orbitotomy (anterior or lateral). During biopsy a specimen is sent to an ophthalmic pathologist who helps determine the exact diagnosis. Dr. Finger has developed a small incision method of orbital biopsy called “FACT.”
When possible, orbital tumors are totally removed. If they cannot be removed or if removal will cause too much damage to other important structures around the eye, a piece of tumor may be removed, sent for evaluation by a pathologist and the patient is treated with radiation and/or chemotherapy. Occasionally an orbital tumor is too big or involves the sinuses and requires more extensive surgery with bone-flaps.
If tumors cannot be removed during surgery, most orbital tumors can be treated with external beam radiation therapy. Certain rare orbital tumors require removal of the eye and orbital contents. However, in select cases alternative therapies (e.g. orbital radiotherapy and chemotherapy) can be used to treat residual tumor to spare vision and the eye.