Benign tumors of the eye socket

Vascular neoplasms predominate in this group (25%), neurogenic tumors (neurinoma, neurofibroma, tumors of the optic nerve) make up 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.) is generally 7%. Congenital neoplasms (dermoid and epidermoid cysts) are detected in 9.5% of patients.

Benign orbital tumors are characterized by a common clinical picture: eyelid edema, stationary exophthalmos, difficulty in repositioning and limiting eye mobility, changes in the fundus, decreased vision, pain in the affected orbit and the corresponding half of the head. A small tumor located at the apex of the orbit may be asymptomatic for a long time.

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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 canals lined with flattened endothelial cells; there is no direct transition of tumor vessels into the vessels of the surrounding orbital tissues. Clinically, the tumor is characterized by slowly increasing stationary exophthalmos. Its close location to the sclera leads to the formation of folds of the vitreous plate (Bruch's membrane) on the fundus and dry dystrophic foci in the paramacular region. Reposition of the eye, despite sufficient elasticity of the hemangioma, is usually difficult. Deeper localization of cavernous hemangioma (at the apex of the orbit) may be accompanied by pain in the affected orbit and the corresponding half of the head. Usually, with such localization, a picture of congestion of the optic nerve head or its primary atrophy appears early.

The diagnosis is clarified using computed tomography, which reveals a cellular rounded shadow with smooth contours, delimited from the surrounding tissues by the shadow of the capsule. The intensity of the tumor shadow increases in the case of its contrast. Ultrasound scanning reveals a tumor shadow limited by a capsule.

Treatment of cavernous hemangioma of the orbit is surgical. Given the emerging possibilities of precise tumor topography using computed tomography and microsurgical techniques, it is recommended to perform surgery immediately after diagnosis. There is no reason to wait for the progression of clinical symptoms, since their appearance can lead to irreparable loss of visual functions.

Neurogenic tumors are derivatives of a single germ layer of neuroectoderm, but differ in morphological picture. Tumors of the optic nerve are represented by meningioma and glioma.

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Orbital meningioma

Meningioma appears at the age of 20-60 years, more often in women. The tumor develops from the arachnoid villi located between the dura mater and arachnoid mater. The diameter of the optic nerve affected by the tumor increases 4-6 times and can reach 50 mm. Meningioma is capable of growing through the optic nerve sheaths and spreading to the soft tissues of the orbit. As a rule, the tumor is unilateral, characterized by exophthalmos with an early decrease in vision. When the tissues of the orbit grow, there is a limitation of eye movements. On the fundus - a sharply expressed congestion of the optic nerve disk, less often - its atrophy. The appearance of significantly dilated veins of a bluish color on the congestion disk indicates the spread of the tumor directly to the posterior pole of the eye.

Diagnosis of meningioma is difficult, since even on CT scans, especially in the early stages of the disease, the optic nerve is not always enlarged enough to suggest tumor damage.

Treatment for orbital meningioma is surgery or radiation therapy.

The prognosis for vision is unfavorable. If the tumor grows along the optic nerve trunk, there is a risk of its spreading into the cranial cavity and affecting the chiasm. The prognosis for life is favorable if the tumor is located within the orbital cavity.

Orbital glioma

Glioma usually 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 are slightly more likely to get sick. Only the optic nerve is affected in 28-30% of patients; in 72%, optic nerve glioma is combined with chiasm damage. The tumor consists of three types of cells: astrocytes, oligodendrocytes, and macroglia. It is characterized by an extremely slow but steadily progressive decrease in visual acuity. In children under 5, the first sign that parents pay attention to is strabismus, nystagmus is possible. Exophthalmos is stationary, painless, appears later and increases very slowly. It can be axial or with displacement with eccentric tumor growth. Repositioning of the eye is always difficult. Congestive disc or optic nerve atrophy are equally often detected on the fundus. When the tumor grows near the scleral ring, the swelling of the optic disc is especially pronounced, the veins are significantly dilated, tortuous, with a bluish tint. Hemorrhages near the disc occur due to obstruction of the central retinal vein. Unlike meningioma, glioma never grows into the dura mater, but can spread along the optic nerve trunk into the cranial cavity, reaching the chiasm and the contralateral optic nerve. Intracranial spread is accompanied by dysfunction of the hypothalamus, pituitary gland, and increased intracranial pressure.

The diagnosis of glioma is established based on the results of computed tomography, which can not only visualize the enlarged optic nerve in the orbit, but also judge the spread of the tumor along the optic nerve canal into the cranial cavity. Ultrasound scanning is not informative enough, since it only presents an image of the proximal and middle thirds of the optic nerve. Given the extremely slow growth of the tumor, treatment is strictly individual. If vision is preserved and the patient can be monitored, an alternative to long-term monitoring may be radiation therapy, after which stabilization of tumor growth is observed, and in 75% of patients - even an improvement in vision.

Surgical treatment of orbital glioma is indicated when the tumor affects only the orbital segment of the optic nerve in cases of rapidly progressing vision loss. The question of preserving the eye is decided before surgery. If the tumor grows to the scleral ring, which is clearly visible on CT scans, the affected optic nerve is subject to removal along with the eye, and the child's parents must be warned about this. If the tumor spreads to the optic nerve canal or cranial cavity, the question of the possibility of performing surgical intervention is decided by a neurosurgeon.

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

Orbital neuroma

Neurinoma (synonyms: lemmoma, schwannoma, neurolemmoma) accounts for 1/3 of all benign orbital tumors. The age of patients at the time of surgery is from 15 to 70 years. Women are slightly more often affected. In the orbit, the source of this tumor in most cases are the ciliary nerves, supratrochlear or supraorbital, it can also form from lemmocytes of the sympathetic nerves innervating the vessels of the meningeal sheath of the optic nerve and the retinal artery. One of the first signs of the tumor may be localized pain in the affected orbit, non-inflammatory edema of the eyelids (usually the upper one), partial ptosis, diplopia. In 25% of patients, exophthalmos, axial or with displacement, attracts attention first of all. The tumor is most often located under the upper orbital wall in the external surgical space. The zone of cutaneous anesthesia allows us to assume the "interest" of the supratrochlear or supraorbital nerve. At 1/4patients have corneal anesthesia. A large tumor limits the mobility of the eye in the direction of its localization. Changes in the fundus are found in 65-70% of patients, most often swelling of the optic nerve is noted.

Ultrasound scanning allows visualization of the tumor shadow, delimited by the capsule. A CT scan shows not only the tumor shadow, but also its relationship with the optic nerve. The final diagnosis is established after histological examination.

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

The prognosis for vision and life is favorable.