Benign tumors of the orbit

Vascular neoplasms dominate in this group (25%), neurogenic tumors (neurinoma, neurofibroma, optic neoplasms) are about 16%. Benign tumors of epithelial origin develop in the lacrimal gland (pleomorphic adenoma), they account for no more than 5%. The incidence of soft tissue tumors (teratoma, fibroma, lipoma, mesenchymoma, etc.) as a whole is 7%. Congenital neoplasms (dermoid and epidermoid cysts) reveal in 9.5% of patients.

For benign orbital tumors, the general clinical picture is typical: eyelid edema, stationary exophthalmos, difficulty in repositioning and limiting the mobility of the eye, changes in the fundus, loss of vision, pain in the affected orbit and the corresponding half of the head. A small tumor located at the apex of the orbit can be asymptomatic for a long time.

[1], [2], [3], [4]

Cavernous hemangioma of the orbit

Vascular tumors are most often (up to 70% of cases) represented by cavernous hemangioma. The tumor is detected at the age of 12-65 years, in women 2.5 times more often; it has a well-defined pseudocapsule. Microscopically cavernous hemangioma consists of large dilated vascular channels lined with flattened endothelial cells, there is no direct transfer of the tumor vessels into the vessels of surrounding orbital tissues. Clinically, the tumor is characterized by a slowly increasing steady-state exophthalmos. Its close arrangement at the sclera leads to the formation on the fundus of the folding of the vitreous plate (Bruch's membrane) and dry dystrophic foci in the paramacular region. Reposition of the eye, in spite of sufficient elasticity of the hemangioma, is usually difficult. Deeper localization of cavernous hemangioma (at the apex of the orbit) can be accompanied by pain in the affected orbit and the corresponding half of the head. Usually, with such a localization, a picture of the congestive optic nerve disk or its primary atrophy occurs early.

The diagnosis is clarified with the help of computed tomography, in which a cellular rounded shadow with smooth contours is identified, delimited from the surrounding tissues by the shadow of the capsule. The intensity of the shadow of the tumor increases in the case of its contrast. With ultrasound scanning, a shadow of the tumor is detected, bounded by a capsule.

Treatment of cavernous hemangioma of the orbit surgical. Given the emerging opportunities for clear tumor topometry using computed tomography and the use of microsurgical techniques, it should be recommended to perform the operation immediately after diagnosis. There is no reason to wait for the progression of clinical symptoms, since their appearance can lead to an irreparable loss of visual functions.

Neurogenic tumors are derived from a single embryonic layer of the neuroectoderm, but differ in the morphological pattern. Tumors of the optic nerve are represented by meningioma and glioma.

[5], [6], [7]

Meningitis of the eye socket

Meningioma appears at the age of 20-60 years, more often in women. The tumor develops from arachnoid villi located between the solid and arachnoid shells. The diameter of the optic nerve affected by the tumor increases by 4-6 times and can reach 50 mm. Meningioma is able to germinate the optic nerve shell and spread to soft tissues of the orbit. As a rule, the tumor is one-sided, characterized by exophthalmos with an early decrease in vision. When the orbital tissues germinate, there is a limitation of eye movements. On the fundus there is a pronounced stagnant disk of the optic nerve, less often - its atrophy. The appearance of significantly enlarged veins of cyanotic color on a stagnant disc indicates the spread of the tumor directly to the posterior pole of the eye.

Diagnosis of a meningioma is difficult, since even on computer tomograms, especially in the initial stage of the disease, the optic nerve is not always so enlarged to suggest its tumor lesion.

Treatment of the orbital meningioma is an operation or radiotherapy.

The prognosis for sight is unfavorable. With the growth of the tumor along the trunk of the optic nerve, there is a threat of its spread into the cavity of the skull and defeat of the chiasma. The prognosis for life is favorable when the tumor is located within the orbit cavity.

Glioma eye sockets

Glioma, as a rule, develops in the first decade of life. However, in recent decades, the literature has described an increasing number of cases of tumor detection in people over 20 years of age. Women get sick more often. The lesion of the optic nerve alone is observed in 28-30% of patients, in 72% of the glioma of the optic nerve is combined with the defeat of the chiasma. The tumor consists of three types of cells: astrocytes, oligodendrocytes and macroglias. Characterized by extremely slow, but steadily progressing decline in visual acuity. In children under 5 years, the first sign that parents pay attention to is strabismus, nystagmus is possible. Exophthalmic is stationary, painless, appears later and grows very slowly. It can be axial or offset with eccentric growth of the tumor. Reposition of the eye is always difficult. On the eye bottom, the stagnant disc or atrophy of the optic nerve is equally often detected. With the growth of the tumor near the scleral ring, the edema of the optic disc is especially pronounced, the veins are considerably enlarged, convoluted, with a bluish tinge. Hemorrhages near the disc arise from the obstruction of the central vein of the retina. Unlike meningioma, glioma never sprouts the dura mater, but along the trunk of the optic nerve can spread into the cavity of the skull, reaching the chiasma and the contralateral optic nerve. Intracranial spread is accompanied by a violation of the functions of the hypothalamus, pituitary gland, increased intracranial pressure.

The diagnosis of glioma is established on the basis of the results of computed tomography, with the help of which it is possible not only to visualize the enlarged optic nerve in orbit, but also to judge the spread of the tumor along the optic nerve channel into the cranial cavity. Ultrasound scanning is not very informative, since it represents the image of only the proximal and middle third of the optic nerve. Given the extremely slow growth of the tumor, treatment is strictly individual. With preservation of vision and the possibility of monitoring a patient, an alternative to prolonged follow-up may be radiation therapy, after which tumor growth stabilizes, and in 75% of patients, even vision is improved.

Surgical treatment of the glioma of the orbit is indicated when the tumor only affects the orbital segment of the optic nerve in cases of rapidly progressive decline in vision. The issue of eye preservation is decided before surgery. If the tumor sprouts up to the scleral ring, which is clearly visible on computer tomograms, the affected optic nerve is to be removed with the eye, and this should be sure to warn the child's parents. In the case of the spread of the tumor into the optic canal or the cranial cavity, the question of the possibility of performing surgical intervention is decided by the neurosurgeon.

The prognosis for vision is always bad, but for life it depends on the spread of the tumor into the cranial cavity. When involved in the tumor process chiasma, mortality reaches 20-55%.

Neurinoma of the eye socket

Neurinoma (synonyms: lemma, schwannoma, neurolemmoma) is 1/3 of all benign orbital tumors. Age of patients at the time of surgery from 15 to 70 years. Women get sick more often. In the orbit, the source of this tumor in most cases is the ciliary nerves, supra-oralic or nadirbital, it can also be formed from the lemocytes of the sympathetic nerves, innervating the vessels of the meningeal shell of the optic nerve and the retinal artery. One of the first signs of a tumor may be localized pain in the affected orbit, non-inflammatory eyelid edema (often the upper one), partial ptosis, diplopia. In 25% of patients, exophthalmos, axial or offset, attract attention. The tumor is often located under the upper orbital wall in the outer surgical space. The zone of cutaneous anesthesia suggests the "interest" of the supraclavicular or peritoneal nerve. 1/4patients are anesthetized cornea. A large tumor restricts the mobility of the eye toward its localization. Changes on the fundus reveal in 65-70% of patients, more often ascertain the edema of the optic nerve disk.

With ultrasound scanning, one can visualize the shadow of the tumor, delimited by the capsule. On a computer tomogram, you can see not only the shadow of the tumor, but also its relationship with the optic nerve. The final diagnosis is established after histological examination.

Treatment of neurinoma of the orbit is surgical only. An incompletely removed tumor is prone to recurrence.

The prognosis for vision and life is favorable.