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Orbital Tumors in Adults

Frank A. Nesi, MD, FACS · César A. Sierra, MD

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	Slide 1A. Classically, cavernous hemangiomas lie in the intraconal space. The CT scan will typically show a round, well-circumscribed lesion in the retrobulbar space. Treatment is surgical, usually with a lateral approach to adequately expose the lesion.
	Slide 1B. Classically, cavernous hemangiomas lie in the intraconal space. The CT scan will typically show a round, well-circumscribed lesion in the retrobulbar space. Treatment is surgical, usually with a lateral approach to adequately expose the lesion.
	Slide 2. Lymphangiomas are known to be infiltrative and poorly circumscribed lesions. CT scan and MRI are helpful showing the location of the lesions as well as its relation with adjacent structures. Unlike hemangiomas, cysts can be seen within these lesions. Another distinguishing element is the absence of phleboliths.
	Slide 3. High-flow fistulas such as carotid-cavernous fistulas most commonly develop after trauma. The larger degree of shunting will result in increased venous pressure with arterialization of episcleral vessels causing secondary glaucoma. Other signs and symptoms include pain, exposure keratopathy, bruit, pulsatile exophthalmos, swelling of the periocular and orbital tissues, signs of decreased perfusion, and variable cranial nerve involvement with sixth cranial nerve palsy being the most common.
	Slide 4. Detailed, high-resolution arteriovenous imaging and occasionally arteriography are required in the diagnosis of high-flow fistulas. An enlarged superior ophthalmic vein is characteristic, but not pathognomonic of, carotid-cavernous fistulas.
	Slide 5. Dermoids may erode bone and even create bony defects with intracranial extension. Differential diagnosis may include mucoceles and encephaloceles medially and lacrimal tumors laterally in the lacrimal fossa. Treatment consists of total surgical excision of the cyst.
	Slide 6A. Lymphoid lesions may present under the conjunctiva as a fleshy mass, also known as a “salmon patch,” in the lacrimal gland or deeper in the orbit. Displacement of the globe occurs late due to its typical molding quality that spreads around the ocular and orbital structures. CT scan shows the putty-like molding appearance and defines the extension of these lesions.
	Slide 6B. Lymphoid lesions may present under the conjunctiva as a fleshy mass, also known as a “salmon patch,” in the lacrimal gland or deeper in the orbit. Displacement of the globe occurs late due to its typical molding quality that spreads around the ocular and orbital structures. CT scan shows the putty-like molding appearance and defines the extension of these lesions.
	Slide 7. Orbital exenteration and aggressive radiotherapy are the standard of care of adenoid cystic carcinomas. These are the most common malignant epithelial tumors of the lacrimal gland. Prognosis is poor secondary to perineural extension into structures adjacent to the orbit and even metastasis at the time of presentation.