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Public Science Insights: More Than a Migraine: Tumors in the Orbit

Posted Wed, Mar, 15,2017

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Light sensitivity and headaches are typical complaints of those suffering from migraines. Often, these diagnoses are relatively untested given their commonplace occurrence. Congestion hardly warrants an x-ray, right? However, the same symptoms attributed to a common migraine may be indicative of something more severe.

The orbit is the part of the head that houses the eyeball along with its muscles, blood vessels, nerves, and connective tissue. An orbital tumor is usually referred to as the neoplasm that originates from any of the tissue surrounding the eyeball. Malignant tumors from other parts of the body can also metastasize into the orbit.  Since this crowded “house” is wide in the front and narrow in the back, even a very small tumor may cause significant symptoms. Large tumors may push the eyeball forward and have adverse effects on the visual and movement function of the eye. The most common clinical presentations include: bulging of the eyeball, double vision or decreased vision, redness of the eye, incomplete lid closure, and ocular pain. 

There are a number of different types of tumors in the orbit according to their origins:

 

  • Hemangiomas and lymphangiomas arise from the vascular system
  • Osteomas develops in the bone
  • Sarcomas originate from fatty tissue or muscle
  • Capillary hemangioma and lymphangioma, are benign and often found in children
  • Rhabdomyosarcoma and lymphoma are malignant

 

The reason for tumor development in the orbit is largely unknown. Perhaps a combination of genetic and environmental factors are at play as some chromosome abnormalities have been detected in certain type of sarcoma and is now recommended to assist diagnosis.

Computed tomography (CT) CT and magnetic resonance imaging (MRI) are widely used in the diagnosis of orbital tumors. In figure 1, we can easily see a soft tissue tumor in the right lateral orbital wall area with the protruding eyeball However, a definitive diagnosis relies on the biopsy from the tumor tissue which is examined under the microscope. 

Some orbital tumors are benign. So if it is a small one and does not cause any symptoms, it may be followed up with observation. However, if you should take notice of significant symptoms with abnormal visual function, surgical removal is usually the best option when possible. In some types of malignant tumors, radiation and chemotherapy may be used as an adjunct to surgery. Such combined therapy is usually carried out by a team of ophthalmologists, neurosurgeons, and oncologists.

The outcome and prognosis of orbital tumors depend on the pathological diagnosis. Some with malignant tumors such as sarcoma, have very poor prognosis; while others with benign tumors may have good outcome.

Dr. Peggy Xu is the author of the recently published paper "Tumors in the Orbit," available for download now in Opthamology and Eye Diseases

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