Metastatic tumors of the eye

Metastatic tumors in children

Neuroblastoma

Neuroblastoma is one of the most common malignant tumors in children. Neuroblastoma originates from primitive neuroblasts of the sympathetic trunk, most often in the abdomen, less often in the chest and pelvis. Neuroblastoma usually affects young children and, as a rule, is already generalized at the time of diagnosis, so it has an extremely poor prognosis. Metastases to the orbit can be bilateral, appear suddenly and grow rapidly, which is manifested by exophthalmos, the presence of tissue in the upper parts of the orbit and ecchymosis of the eyelids.

Granulocytic sarcoma (chloroma)

Granulocytic sarcoma - this localized tumor is represented by malignant cells of myeloid origin. The tumor may have a characteristic green color, which is why it was formerly called chloroma. Granulocytic sarcoma may be a symptom of myeloid leukemia or precede this disease. The first manifestations are at about 7 years of age in the form of rapidly developing exophthalmos, sometimes bilateral, which is often combined with ecchymosis and eyelid edema. When orbital involvement precedes systemic leukemia, diagnosis is difficult.

Langerhans cell histiocytosis (granulomatosis)

This is a rare, poorly understood, multisystem disorder characterized by a destructive inflammatory process with primary bone involvement. Soft tissue involvement is less common, but cutaneous and visceral lesions occur. In patients with isolated lesions (eosinophilic granuloma), the disease usually has a benign course and responds well to treatment. Orbital involvement may be unilateral or bilateral, with osteolysis and soft tissue involvement, most commonly in the superotemporal quadrant.

Metastatic tumors in adults

In adults, orbital metastases are less common than choroidal metastases. If symptoms begin in the orbit, the ophthalmologist is the first doctor the patient consults. The sources of metastases are (in descending order): mammary gland, bronchi, prostate gland, skin melanoma, gastrointestinal tract, and kidneys.

Symptoms

• A mass in the anterior orbit causing displacement of the eye or exophthalmos is the most common symptom.
• Infiltration of orbital tissues, characterized by ptosis, diplopia, pronounced compaction of the periorbital skin and orbital tissues, which results in difficulty in repositioning.
• Enophthalmos in scirrhous tumors.
• Chronic inflammatory process in the orbit.
• When localized at the apex of the orbit, the function of the cranial nerves (II, III, IV, V, VI) is primarily impaired, and exophthalmos is weakly expressed.

Diagnostics

• CT-guided fine-needle biopsy is used for histological confirmation. If it is uninformative, an open biopsy is performed;
• Hormonal studies on tissue samples can be used to develop specific hormone therapy for hormone-dependent tumors.

The goal of treatment is to preserve vision and control pain, since most patients die within 1 year.

Radiotherapy is the treatment of choice. Sometimes, when other methods are ineffective and the symptoms are intolerable, orbital exenteration is indicated.

Orbital invasion of sinus tumors

Malignant tumors of the paranasal sinuses can very rarely grow into the orbit, which indicates a poor prognosis even if diagnosed early. In this regard, it is important for the physician to understand the otolaryngological and ophthalmological signs of these conditions.

Maxillary cancer is the most common sinus tumor that invades the orbit.

• otolaryngological signs: facial pain, congestion and swelling. Facial swelling in advanced maxillary sinus carcinoma, nosebleeds and nasal discharge;
• Ophthalmological signs: upward displacement of the eye, diplopia and epiphora.

Ethmoid sinus cancer can displace the eye outward.

Nasopharyngeal cancer grows into the orbit through the superior orbital fissure. Exophthalmos occurs late.