Introduction

•Eye Tumors can :▫Be live threatening▫Reduce vision▫Cause cosmetic problems

Eye Tumor Classification

•External : on palpebra, conjunctiva, cornea and lacrimal sac.

•Intraocular

•Orbital

Benign External Eye Tumor

•Dermoid cyst and dermoid tumor•Xanthelasma•Millium•Papilloma•Nevus•Verruca vulgaris = Common wart•Molluscum contagiosum

Malignant External Tumor

•Carsinoma in situ•Basal cell carcinoma •Squamous cell carcinoma •Aquired melanosis •Lacrimal sac tumor

Intraocular Eye Tumor

•Malignant melanoma.

•Retinoblastoma.

•Uveal metastatic tumor.

Orbital Tumor (1)

•Hemangioma•Neurogenic Tumor :Optical nerve

glioma•Meningioma •Neurofibroma •Rhabdomysarcoma

Orbital Tumor (2)

•Lacrimal gland tumor : Benign mixed tumor

Adenoid cystic carcinoma•Metastatic tumor•Malignant lymphoma•Idiopathic orbital inflammatory desease•Dysthyroid ophthalmopathy

Dermoid Cysts

•Congenital tumor•The tumor wall consists of dermis and

epidermis layer•Location : supero-temporal •Tumor palpation : firm, round, and

smooth, freely mobile under the skin.•T/ : In toto excision

Dermoid Cysts

Dermoid Tumor

•Congenital, located at the limbus•Consists of connective tissue with hair

follicles & sebaceus gland, walled by stra- tified squamous epithelium

•Signs : solid, smooth, round, protruded mass, whitish in colour

•T/ : excision

Dermoid Tumor

Nevus = Benign Melanoma(1)

•Consists of pigment stained cells•Observed in children, grows during

puberty with increase pigmentation•Nevus cells can be found in the :

▫Epidermis: Junctional nevus ▫Dermis: Compound nevus ▫Whole dermic layers : Intradermal nevus

Nevus = Benign Melanoma(2)•Malignant degeneration can happen to

junctional & intradermal nevus•Signs : slightly elevated, pigment

stained, clearly defined lesion•T/ : Excision• Excision indications :

▫Cosmetic▫irritation ▫rapid tumor’s growth

Nevus = Benign Melanoma

Papilloma

•Location : margo palpebra and limbus•Signs : tumor mass is cauliflower-like

and pedunculated•Large tumor size can resembles

malignancy•Has regrowth tendency•Related to viral infection.•T/ : In toto excision.

Verruca vulgaris•Not a true tumor

•Etiology : viral

•Shape : various

•T/ : excision

Molluscum Contagiosum•Etiology : a pox viral

•Signs : small, pale, waxy, umbilicated nodule

•T/ : excision

Intraepithelial epithelioma = Carsinoma in situ = Bowen Desease•Location :cornea, conjungtiva,

palpebral skin•Age 60, particularly men•Signs : Diffuse lesion, elevated, hyper-

keratotic nodule•T/ : In toto excision

Carsinoma in situ

Basal Cell Carsinoma

•Known as Basal cell epithelioma•90-95% of malignant eyelid tumors•Age 50-55 y, particularly men•Signs : ulcerative small node, with

elevated border•Rarely cause metastasis

Therapy for Basal Cell Carsinoma:

•Wide excision with 2 mm safety margin, controlled by frozen section

•Radiotherapy

•Cryotherapy•Mohs’ Chemosurgery•Curetage and electrodessication

Basal Cell Carsinoma

Squamous Cell Carsinoma•2 - 9 % of eyelid malignancies•More aggressive tumor than BCC•Slow growth•Metastasis to regional lymph nodes•Sign : plaque-like, nodular, ulcerating

tumor•T/ : similar to basal cell carcinoma

Squamous cell carcinoma

Acquired Melanosis• Manifestation :

Precancerous or cancerous

• Precancerous : at age 40-60 y, becomes malignant after 5-10 y

• Signs : diffuse pigmentation

• Treatment : wide conjunctivectomy with adjuvant irradiation

• Cancerous : excenteration

Lacrimal Sac Tumor

•Rarely found•45 % benign : papiloma•55% malignant : carcinoma•Sign : tumor mass +

epiphora •Treatment : total excision

and irradiation

Intraocular Malignant Melanoma

•Iris Melanoma : 6-8%

•Uveal melanoma : 9%

•Choroidal Melanoma : 85%

Iris Melanoma

• Sign : pigmented or nonpigmented nodule, >3mm in diameter and >1mm in thickness

• Angle involvement, if extensive, may give rise to secondary glaucoma

• T/ : Small tumors : iridectomy Diffusely growing tumor : enucleation

Ciliary Body Melanoma•Often recognized clinically after it

pushes the iris anteriorly•Sign: depend on the size and location

of the tumor•Extraocular extension through the

scleral emissary vessels may produce a dark epibulbar mass

•T/ : iridosiclectomy or enucleation

Choroidal Melanoma

• Signs : elevated, subretinal, oval-shaped mass

• Frequently brown, may be amelanotic

• Mushroom-shaped appearance as it breaks through the Bruch membrane

• T/ Small tumors : observation

• Very large tumors : enucleation

• Extensive extraocular extension : excenteration

Metastatic tumor to Uvea•The most frequent primary-tumor site is :

▫The breast in women▫The bronchus in men

•Signs : fast growing, creamy-white, placoid or oval lesion most frequently at macula

•T/ : Radiotherapy, Systemic therapy Enucleation for a painful blind

eye

Metastatic tumor to Uvea

Retinoblastoma•The most common primary, malignant,

intraocular tumor of childhood•Occurring in about 1:20.000 live birth•No sexual predilection•The vast majority become clinically

apparent before the age of 3 years

Genetic Aspects of Retinoblastoma•Non heritable account for 60% of cases•The tumors arises at the somatic level in a

single retinal cell•Heritable account for 40 % of cases.•The primitive retinal cells are predisposed

to malignant transformation•Only 6% have a positive family history

Presentation of Retinoblastoma•Leukocoria (white pupillary reflex), in

about 60% cases.•Strabismus, in 20% of cases•Secondary glaucoma•Anterior segment invasion•Orbital inflamation•Proptosis•Metastasis•Routine exam to risk patients

Retinoblastoma

Signs of Retinoblastoma•Early intraretinal

tumor : a flat or round white lesion

•Endophytic tumor : white mass, secondary calcification

•Exophytic tumor : Multiglobulated white mass with retinal detachment.Vitreus hemorrhage

Retinoblastoma Special Investigations

•Ultrasonography

•CT-Scan : to detect calsification

•MRI : to detect optic nerve infiltration

Retinoblastoma Treatment

•Unilateral cases : enucleation, including about 10 mm of optic nerve

•Bilateral cases : enucleation of the worse eye, irradiation of the fellow eye

•Extraocular growth : excenteration•Metastasis : palliative radiotherapy or

chemotherapy

Retinoblastoma Treatment

Retinoblastoma Prognosis

•Optic nerve : * uninvolved : 8%

mortality rate * involved : 65 % mortality rate

•The tumor involves the lamina cribosa : 15% mortality rate

Capillary Hemangioma•Appear at the first month after birth•Strawberry birthmark on palpebral skin•1st year enlargement followed by

regression•T/ :

▫Steroid, low dosage of irradiation▫Dysfunction or marked deformity

indication of excision

Capillary Hemangioma

Cavernous Hemangioma•Benign orbital tumor most frequently

found in adults•Signs : slow progressive exophthalmos;

can cause strabismus, diplopia, optic nerve compression

•Age : 20-40 year•D/ : USG and CT-Scan•T/ : Extirpation

Rhabdomyosarcoma•The most common primary orbital

malignant tumor in children.•Presentation : rapidly progressive

proptosis on children 7 year of age •Sign : A palpable mass at nasal

superior orbit•Swelling and injection of overlying skin

but the skin is not hot•D/ : USG and CT, biopsy•T/ : Irradiation and chemotherapy

Rhabdomyosarcoma

Pleomorphic Lacrimal Gland Adenoma (Benign Mixed Tumor)• Lacrimal gld. most

common epithelial tumor • The fifth decade of life• Painless, slowly

progressive swelling in the upper outer quadrant

• D/ : X-ray, CT• T/ : In toto surgical

excision without prior biopsy

Lacrimal gland carsinoma (Adenoid cystic carsinoma)

•A high morbidity and mortality rare tumor

•Presentation : 40-60years of life•Tends to spread perineurally with bone

destruction•T/: Excenteration and mid-facial

resection Radiotherapy + local resection

Metastatic Tumor in Children

•The most common metastatic tumor in children is :

* Neuroblastoma * Ewing Sarcoma

* Leukemia•T/ : Palliative local irradiation

Malignant Lymphoma

•Location : subconjunctiva and lacrimal gland•The tumor maybe primary or disseminated•Signs : exphthalmos and vision impairment•D/ : X- ray, USG, CT, Biopsy•T/ : Irradiation for localized lesions

Chemotherapy for disseminated disease

Idiopathic Orbital Inflammatory Disease (Orbital Pseudotumor)•Non-neoplastic and non-infectious,

space-occupying orbital lesions•Abrupt painful onset in 20-50y of

age •Signs : periorbital swelling,

chemosis and conjunctival inflammation

•Proptosis, ophthalmoplegia, optic nerve dysfunction may be present

•T/: systemic steroids

Dysthyroid Ophthalmopathy

• Female : Male = 8 : 1• Patients’ age : 20-45 years• Clinical features :

▫Darymple’s sign▫Von Graefe’s sign▫Exophthalmos▫Diplopia▫Periorbital and lid swelling ▫Conjuctival hyperaemia

Dysthyroid Ophthalmopathy

•D/ : Blood T4,T3

•USG and CT

•T/ : High dose of steroid

Disthyroid Ophthalmopathy

Evisceration

Excenteration