Orbital tumors can be benign or malignant and arise primarily within the orbit or secondarily from an adjacent source, such as the eyelid, paranasal sinus, or intracranial compartment. Orbital tumors can also be metastatic from distant sites.
Some types of orbital tumors usually cause proptosis and displacement of the globe in a direction opposite the tumor. Pain, diplopia, and vision loss may also be present. The diagnosis of orbital tumors is suspected based on the history, examination, and neuroimaging (CT, MRI, or both), but confirmation often ultimately requires a biopsy. Causes and treatment vary by age group.
Children
Benign pediatric tumors are most commonly dermoid tumors and vascular lesions such as infantile hemangioma and lymphatic malformations (12).
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Malignant pediatric tumors are most commonly rhabdomyosarcoma and metastatic lesions related to leukemia or neuroblastoma. If rhabdomyosarcoma is resectable, surgery is done, followed by chemotherapy and orbital radiation therapy. Leukemic disease is usually managed by orbital radiation therapy, chemotherapy, or both.
Adults
Benign adult tumors are most commonly meningiomas, mucoceles, and cavernous venous malformations (previously known as cavernous hemangiomas) (3). Pleomorphic adenomas of the lacrimal gland are less common. When symptomatic, sphenoid wing meningiomas are treated with debulking via craniotomy, sometimes followed by a course of radiation therapy. Because meningioma cells infiltrate bone of the skull base, complete resection usually is not possible. Mucoceles are treated by draining them into the nose because they most commonly arise from the ethmoid or frontal sinus. Cavernous venous malformations (the most common benign orbital tumor) and lacrimal gland pleomorphic adenomas are excised.
Malignant adult tumors are most commonly lymphoma, squamous cell carcinoma, and metastatic disease. Less commonly, the tumor is an adenoid cystic carcinoma of the lacrimal gland, which is an aggressive tumor.
Most squamous cell carcinomas arise from the adjacent paranasal sinuses. Surgery, radiation therapy, or both form the backbone of therapy.
Metastatic disease is usually treated with radiation therapy. Metastatic disease involving the orbit is usually an unfavorable prognostic sign; carcinoid tumors are a notable exception.
Lacrimal gland adenoid cystic carcinoma is treated with surgery and then usually with radiation therapy (sometimes proton beam therapy) or by a protocol using intra-arterial chemotherapy with radiation therapy and surgery.
General references
1. Shields JA, Bakewell B, Augsburger JJ: Space-occupying orbital masses in children. A review of 250 consecutive biopsies. Ophthalmology 93(3):379-384, 1986. doi: 10.1016/s0161-6420(86)33731-x
2. Shoji MK, Shishido S, Freitag SKOphthalmic Plast Reconstr Surg 36:215-221, 2020. doi: 10.1097/IOP.0000000000001518
3. Bonavolontà G, Strianese D, Grassi P, et al: An analysis of 2,480 space-occupying lesions of the orbit from 1976 to 2011. Ophthalmic Plast Reconstr Surg 29(2):79-86, 2013. doi: 10.1097/IOP.0b013e31827a7622
