What are they?
They are tumors that appear in the tissue around the eye, in the orbital cavity. The orbit is a cavity formed by the bones that contain the eye, the muscles that move it, the optic nerve, veins, nerves and fat that fill the existing space. .
The tumor may originate in any of the orbital structures. The majority are benign tumours that grow slowly and less often they are malignant, but may develop more quickly.
It is normal that orbital tumours cause a bulging and open eye (proptosis) and in some patients the presence of pain around the eye and in eye movements, double vision (dipolpia) and a loss of vision if it affects the posterior part of the eyeball and compresses the optic nerve.
Causes and risk factors
No risk factors for orbital tumours have been described and many of them are of congenital origin, meaning that they are present from birth.
The benign tumours that most frequently appear in adults are mengiomas, mucoceles, cavernous hemangiomas (cavernous venous hemangiomas) and pleomorphic adenomas of the tear gland.
- Optic nerve sheath meningiomas may originate in the meninx optic canal or sphenoid. These tumours originating in the orbital meninxes cause a loss of vision, atrophy of the optic nerve and proptosis.
- Mucoceles are tumours that originate in the paranasal sinuses because of blocked drainage, which causes the gradual growth of a lesion due to the acumulation of mucus secretion and ends up affecting the eye socket. The most common symptoms are displacements of the eye associated with diplopia.
- Cavernous hemangiomas are vascular tumours and affect a higher percentage of women with a slow forming proptosis.
- Pleomorphic adenomas of the tear gland usually manifest themselves as an increase in the volume of the tear gland, under the tail of the eyebrow, which grows slowly and is not very painful.
The most common malignant tumours in an adult are epidermoid carcinomas, lymphomas, metastases and less frequently cystic adenoid carcinomas of the tear gland, which are aggressive tumours.
- Epidermoid carcinomas affect men more often and may invade the eye socket from its origin in the paranasal sinuses, the nasal cavity and nasopharynx.
- Lymphomas may be part of a systemic process (it affects other areas of the body) or may exist in an isolated form in the orbit. Treatment for lymphoma is performed in coordination with oncologists. The metastases that appear in the orbit usually indicate the sign of an unfavorable diagnosis and are more frequent in patients affected by lung or breast adenocarcinoma.
- Cystic adenoid carcinomas of the tear gland are malignant but grow very slowly and gradually invade the tissue around the tear gland.
No methods of prevention against orbital tumours have been described. However, we do recommend frequent eye check-ups and going to the ophthalmologist if you have symptoms of proptosis (bulging, more open eye), diplopia or a loss of vision.
There are different treatments depending on the type of tumour. In the majority of orbtial tumors, the treatment of choice is surgery to remove the tumour by making incisions in the eyelid skin or the conjunctiva.
Meningiomas (if patients have symptoms), the cavernous venous malformations and pleomorphic adenoma of the tear gland are removed.
Mucoceles, however, are treated by nasal drainage, because they usually originate in the ethmoid or frontal sinuses.
In some tumours, treatment is combined with chemotherapy or radiotherapy.
Frequently asked questions
Should I be worried if I notice that one eye has been clearly bigger than the other for a year?
Concerning eye symptoms like proptosis (the name for when an eye is displaced towards the front), it is important to see an ophthalmologist for a thorough examination and imaging tests to rule out orbital lesions.
Years ago I was diagnosed with an orbital tumour, a mengioma, and I had an operation to remove it. Could it grow again?
Any tumour, even after removal, requires regular monitoring by your ophthalmologist including a CT (computerised tomography) or MRI (magnetic resonance imaging) to assess whether the lesion is growing again.