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Orbital tumours

The word “tumour” means a lump or swelling – and these can sometimes occur in the eye socket (also known as the “orbit”). Tumours are usually benign, irrespective of whether they occur in childhood and in adulthood. But there are also harmful, malignant forms, and the most common forms of eye cancer in adults are lymphoma, and metastases from other tumours. These forms can also be found elsewhere in the body, but again, fortunately, these are rare occurrences.

Benign orbital tumours

Benign tumours in the eye socket are often congenital, growing slowly from birth, and typical include dermoid cysts (a cyst filled with skin components, including fat) and haemangioma, a benign vascular tumour where a small collection of blood vessels form, that can grow significantly after birth. Benign tumours can also develop later in life and can occur in any of the different types of tissue in the orbit.

Typical appearance of child with dermoid cyst of the orbit (right eye, left on picture)

Malignant orbital tumours

A malignant tumour in the orbit occurs when body cells divide without inhibition. Sometimes this is caused by a defect in the patient’s immune system, or through genetic mutations. The cells continue to increase in number and form a lump in the orbit that may press on the eyeball and/or cause double vision. Malignant cells can spread through blood vessels or along nerves to other places in the body (where they form elsewhere, these tumours are called metastases).

A rare malignant orbital tumour in childhood is rhabdomyosarcoma, which grows fast and needs urgent treatment. Lymphoma is the most frequent primary malignancy of the orbit in adults, but metastases from tumours elsewhere in the body can also start to grow in the orbit.

Symptoms of orbital tumours

The symptoms of the different types of orbital tumour are:

  • protrusion of one or two eyes;
  • movement of an eye to the outside / inside / above / below;
  • double vision;
  • disturbed vision;
  • usually painless, sometimes painful.

Techniques

The thought of having a lump near to the eye can cause patients a lot of anxiety. If your doctor or ophthalmologist refers you to ELZA for an examination, you will quickly know what the situation is. In addition to extensive ophthalmic examinations, we often request additional imaging from a nearby radiology department. we can assess the size and location and tissue characteristics of the tumour, with a special scan of the head. When choosing a treatment, we not only look at the type of tumour, but also at your overall health.

The treatment of a benign or malignant tumour in the orbit differs. Benign orbital tumours can usually be treated by complete excision.

Hidden incisions

Our surgeons prefer to remove lesions with maximal preservation of cosmesis. Incisions are made in the natural skin folds so that scars are best concealed, hence the term “hidden incisions”. We then examine the “biopsy” – the piece of tumour removed – to see what type of tumour it was, and whether it was malignant or benign.

What if the tumour appears to be malignant after the biopsy? Then our eye surgeons, in collaboration with a team of other specialists provide treatment. In addition to surgery, radiation therapy (radiotherapy) or chemotherapy may also be required if the tumour is malignant. Because our specialists have a great deal of knowledge and experience in treating both benign and malignant orbital conditions, the operating results are generally very good.

Pseudotumours

There are also so-called “pseudotumours” in the orbit, which occur mostly in adults. A pseudotumour is a benign accumulation of inflammatory cells and looks like a swelling. This inflammatory swelling is usually treated with medication, and sometimes an examination by an internist might be necessary to see whether inflammation also occurs elsewhere in the body.

Investigations

It is often not clear from the tumour itself whether it is malignant or not. That is why we often take a biopsy for tissue analysis by a pathologist.

Imaging

A special scan of the orbits is made to examine the expansion and location of any swelling in the orbit. This scan is made in a radiology department.

CT scan showing a tumour in one of the orbits – horizontal line shows the width of the lesion.

Key terms

Biopsy

We carefully remove a small piece of the tumour. This is called a biopsy. This piece is examined microscopically. This way we can see if the tumour is malignant or not.

Facial pictures

The ophthalmologist will photograph your eyes and face, before and after treatment, for documentation.

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