JOURNAL REVIEW JOURNAL REVIEW

ORBITAL TUMOURORBITAL TUMOURDR.BHARTI AHUJADR.BHARTI AHUJA

Orbital tumorsOrbital tumorsBased on originBased on origin Anatomical locationAnatomical location

intraconalintraconal

extraconalextraconal

primaryprimary

secondarysecondary

metastaticmetastaticStructurStructures within es within the orbitthe orbit

Structures in Structures in proximityproximity

to the orbitto the orbit

Abscess due to sinusitisSchwannoma of the V1 and V2 branches of the trigeminal nerve Bone lesions:Fibrous dysplasia of

the sphenoid wingMetastases

Multiple myelomaDiseases of the orbital

appendages

Venous vascular malformationCapillary hemangioma

Optic nerve lesionsOptic neuritis

MSDevic's syndrome

Neuritis due to infection (e.g.herpes zoster)Autoimmune (e.g.Lupus)

Drugs (e.g.chloramphenicol, ethambutol)Optic nerve glioma

Optic nerve meningiomaPseudotumor

Venous dilatationCarotid Cavernous Fistula

VaricesSchwannoma of 3rd, 4th and 6th cranial nerve

Common signs and symptoms Pain Visual loss Diplopia Soft tissue involvement Proptosis Enophthalmos Dystopia Ophthalmoplegia Fundus changes(papilloedema)

ORIGINORIGIN CHILDREN CHILDREN ADULTSADULTS

CongenitalCongenital Dermoid cystDermoid cyst

TeratomaTeratoma

Vascular Vascular Capillary hemangiomasCapillary hemangiomas

LymphangiomaLymphangiomaCavernous Cavernous hemangiomashemangiomas

HemangiopericytomasHemangiopericytomas

NeuralNeural Optic nerve gliomaOptic nerve glioma

Plexiform neurofibromaPlexiform neurofibromaOptic nerve Optic nerve meningiomasmeningiomas

SchwannomasSchwannomas

NeurofibromasNeurofibromas

MesenchymalMesenchymal RhabdomyosarcomaRhabdomyosarcoma Fibrous histiocytomasFibrous histiocytomas

HemopoieticHemopoietic Acute myeloid leukemiaAcute myeloid leukemia

HistiocytosisHistiocytosisLymphomaLymphoma

MetastaticMetastatic NeuroblastomasNeuroblastomas

Wilms tumorWilms tumor

Ewing’s sarcomaEwing’s sarcoma

Breast,lung,prostate Breast,lung,prostate carcinomacarcinoma

Lacrimal gland Lacrimal gland Adenoid cysticAdenoid cystic

Pleomorphic adenomaPleomorphic adenoma

Pleomorphic adeno carcinomaPleomorphic adeno carcinoma

Pleopmorphic adenomasPleopmorphic adenomas

CarcinomasCarcinomas

Common orbital tumoursCommon orbital tumours

Military medical journal of south east china 2009 Diagnosis and treatment of 62

cases of orbital cavernous hemangioma

ZHANG Zhi-qiang,YANG Jian-dong,FAN Qing-hua,CAO Li,LIU Yu,HONG Jin

Objective :To explore the clinical features,imaging diagnosis and treatment of orbital cavernous hemangioma.

Methods A retrospective review of 62 patients with orbital cavernous hemangioma who were seen in Department of Ophthalmolgy,The 81 Hospital of PLA from May,2003 to November,2008.Results Among 62patients,21 cases were males and 41 were females.The right orbit was affected in 36 patients and the left orbit in 26 patients.The mean age was 38.6 years,ranging from 19 to 69 years.Ninety-five percent(58/61) of them could be accurately diagnosed preoperatively by image examination.The tumors were removed successfully by the surgical procedure of anterior orbitotomy in 42 cases and lateral orbitotomy in 19 cases.

Conclusion :Nearly all patients with orbital cavernous hemangioma could be exactly diagnosed by preoperative image examination.The surgical procedure of anterior orbitotomy could be successfully used in a majority of cases.

DIAGNOSTIC TOOLSDIAGNOSTIC TOOLS

Plain x-raysPlain x-rays UltrasonographyUltrasonography CTCT MRIMRI FNABFNAB AngiographyAngiography

Value of MR imaging in the differentiation of benign and malignant orbital tumors in adults.

PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging including dynamic contrast-enhanced MR imaging in the differentiation of benign from malignant orbital masses.

MATERIALS AND METHODS: The study was approved by the institutional review board and signed informed consent was obtained. Nonenhanced, static, and dynamic contrast-enhanced MR imaging was performed in 102 adult patients with an orbital mass. Diagnosis was based on histologic findings. MR imaging features of benign and malignant orbital lesions were evaluated correlated with histological findings. Multivariate logistic regression analysis was employed to identify the best combination of MR imaging features that might be predictive of malignancy RESULTS: Nonenhanced, static, and dynamic enhancement MR imaging was significantly superior to two other models in prediction of malignancy (p < 0.05). Multivariate logistic regression analysis identified that the most discriminating MR imaging features were isointense mass on T2-weighted imaging and a washout-type time-intensity curve for both observers.

CONCLUSION: Nonenhanced, static, and dynamic enhancement MR imaging improved differentiation between benign and malignant orbital masses in adult patients.

EUROPEAN JOURNAL OF RADIOLOGY,FEB 2010

Xian J, Zhang Z, Wang Z, Li J, Yang B, Man F, Chang Q, Zhang Y.

MIDDLE EAST AFRICAN JOURNAL OF OPHTHALMOLOGY(MEAJO),2008,VOL15ISSUE 1, PG 17-27

Orbital pseudotumor: Distinct diagnostic features and management

Imtiaz A Chaudhry, Farrukh A Shamsi, Yonca O Arat, Fenwick C Riley Purpose: To provide an overview of the spectrum of diseases known as 'idiopathic orbital inflammatory syndrome' also known as orbital pseudotumor, with emphasis on specific diagnostic challenges in the evaluation and management of patients with this disorder. Methods:Review of the relevant literature and summarize recent findings regarding the epidemiology, diagnosis, pathophysiology and treatment of orbital pseudotumor. Results : Orbital pseudotumor is a benign intraorbital process confined to the orbit but extra orbital involvement can occur. It is among the 3 rd most common orbital diseases along with thyroid orbitopathy and lymphoproliferative disorder and accounts for 5-10% of orbital processes. Clinically, orbital pseudotumor has been categorized as myositis, dacryoadenitis, anterior, apical and diffuse process. Patients may present with diplopia, conjunctival chemosis, proptosis or abnormal computed tomography scan (CT-scan) findings. Patients may also have associated optic neuropathy. Diagnosis is based on careful history, ultrasonography (U/S), CT-scan and magnetic resonance imaging (MRI) studies which may also provide prognostic information. Treatment consists of systemic corticosteroids in the form of oral or intravenous administration. Confirmation is made by orbital biopsy. In addition to radiation, cytotoxic agents, immunosuppressant, IV immunoglobulin, biological therapy, TNF-alpha inhibitor monoclonal antibody and Mycophenolate Moftil have been found to be useful in the management of refractory orbital pseudotumor. 

 Conclusion: Understanding of the clinical features of patients with orbital pseudotumor, differentiating it from other orbital processes by use of imaging techniques and timely implementation of available treatment strategies may help prevent visual loss and associated morbidity from this condition .

Treatment approaches

Medical-steroids.

Surgery

Radiotherapy

Chemotherapy

International Journal of Radiation Oncology*Biology*Physics ,oct 2009 ,oct 2009Brachytherapy as Part of the Multidisciplinary Treatment of Childhood Brachytherapy as Part of the Multidisciplinary Treatment of Childhood

Rhabdomyosarcomas of the OrbitRhabdomyosarcomas of the Orbit

Rhabdomyosarcomas in the orbit form a major challenge in terms of cure Rhabdomyosarcomas in the orbit form a major challenge in terms of cure without severe side effects in childhood cancer. Our specifically developed without severe side effects in childhood cancer. Our specifically developed

approach consists of applying brachytherapy to the tumor area using a approach consists of applying brachytherapy to the tumor area using a mold. Analysis of its results for 20 patients was performed.mold. Analysis of its results for 20 patients was performed.

Methods and Materials:Methods and Materials:Thirteen patients were referred for brachytherapy if Thirteen patients were referred for brachytherapy if complete remission was not reached after chemotherapy (Group I) and 7 in case of complete remission was not reached after chemotherapy (Group I) and 7 in case of relapse (Group II). In total, 20 patients were treated between 1991 and 2007. Four relapse (Group II). In total, 20 patients were treated between 1991 and 2007. Four

were female and 16 male; their ages varied from 1.1 to 16.5 years, with an average were female and 16 male; their ages varied from 1.1 to 16.5 years, with an average of 8.5 years. After macroscopically radical tumor resection, molds with holes drilled of 8.5 years. After macroscopically radical tumor resection, molds with holes drilled to hold flexible catheters were placed into the orbit. The dose to the clinical target to hold flexible catheters were placed into the orbit. The dose to the clinical target volume was 40–50 Gy. volume was 40–50 Gy. Results:Results:Three patients of Group I and 1 patient of Group II Three patients of Group I and 1 patient of Group II

developed local recurrence and underwent exenteration. The progression-free developed local recurrence and underwent exenteration. The progression-free survival in Group I is 71.9% (95% CI 0.44–1.0), in Group II 85.7% (95% CI 0.60–1.0), survival in Group I is 71.9% (95% CI 0.44–1.0), in Group II 85.7% (95% CI 0.60–1.0), the overall 5-year survival rate of the entire group is 92% (95% CI 0.76–1.0). During the overall 5-year survival rate of the entire group is 92% (95% CI 0.76–1.0). During

treatment, no serious side effects were observed. The late complications treatment, no serious side effects were observed. The late complications encountered in this series were cataract in 2 patients, 1 of whom also developed encountered in this series were cataract in 2 patients, 1 of whom also developed mild retinopathy. Two patients with ptosis needed surgical correction. No facial mild retinopathy. Two patients with ptosis needed surgical correction. No facial

asymmetries or bone growth anomalies were observed.asymmetries or bone growth anomalies were observed.

ConclusionsConclusionsThis entire procedure of brachytherapy with a mold offers a This entire procedure of brachytherapy with a mold offers a tailor-made treatment for orbital rhabdomyosarcomas with tailor-made treatment for orbital rhabdomyosarcomas with

only few signs of late toxicity.only few signs of late toxicity.

Graefes Arch Clin Exp Ophthalmol. 2007 Jul;245(7):1031-5. Graefes Arch Clin Exp Ophthalmol. 2007 Jul;245(7):1031-5. Intralesional injection of OK-432 for vision-threatening orbital lymphangioma.Intralesional injection of OK-432 for vision-threatening orbital lymphangioma.

Yoon JS, , Choi JB, , Kim SJ, , Lee SY..

BACKGROUND: Surgical excision of orbital lymphangiomas is BACKGROUND: Surgical excision of orbital lymphangiomas is difficult, and almost always incomplete due to the diffusely difficult, and almost always incomplete due to the diffusely

infiltrative pattern of these tumors. The present report describes the infiltrative pattern of these tumors. The present report describes the successful use of intralesional OK-432 administration to treat two successful use of intralesional OK-432 administration to treat two

patients with intractable hemorrhagic proptosis due to orbital patients with intractable hemorrhagic proptosis due to orbital lymphangiomas.lymphangiomas.

METHODS: A 3-year-old girl (case 1) presented with aggressive proptosis and ptosis, METHODS: A 3-year-old girl (case 1) presented with aggressive proptosis and ptosis, and a 1-year-old boy (case 2) presented with massive proptosis and exposure and a 1-year-old boy (case 2) presented with massive proptosis and exposure

keratopathy, associated with recurrent intracystic bleeding of an orbital lymphangioma. keratopathy, associated with recurrent intracystic bleeding of an orbital lymphangioma. In case 1, 0.02 mg OK-432 was intracystically injected in a volume of 2 ml of In case 1, 0.02 mg OK-432 was intracystically injected in a volume of 2 ml of

physiologic saline. Due to a lack of therapeutic response, a second injection of 0.05 mg physiologic saline. Due to a lack of therapeutic response, a second injection of 0.05 mg OK-432 in 1 ml was administered. In case 2, a single dose of 0.05 mg OK-432 in 1 ml OK-432 in 1 ml was administered. In case 2, a single dose of 0.05 mg OK-432 in 1 ml

was administered. RESULTS: In both cases, intracystic administration of 0.05 mg of OK-was administered. RESULTS: In both cases, intracystic administration of 0.05 mg of OK-432 in a 1-ml volume resulted in a successful outcome. The adverse effects were minor 432 in a 1-ml volume resulted in a successful outcome. The adverse effects were minor

(mild transient fever and lid swelling), and rebleeding and intraocular pressure (mild transient fever and lid swelling), and rebleeding and intraocular pressure elevation did not occur. Proptosis and eyelid swelling gradually improved over 1 month, elevation did not occur. Proptosis and eyelid swelling gradually improved over 1 month,

and completely resolved within 3 months of treatment. and completely resolved within 3 months of treatment.

CONCLUSIONS: Intralesional administration of 0.05 mg/ml CONCLUSIONS: Intralesional administration of 0.05 mg/ml OK-432 (delivered in 1 ml) resulted in the successful OK-432 (delivered in 1 ml) resulted in the successful

treatment of two cases of orbital lymphangioma. Although treatment of two cases of orbital lymphangioma. Although this drug concentration is higher than in previous reports, this drug concentration is higher than in previous reports,

there were no major adverse effects.there were no major adverse effects.

JOURNAL OF NEUROSURGICAL SCIENCE,2009,SEP,53(3),pg-77-91JOURNAL OF NEUROSURGICAL SCIENCE,2009,SEP,53(3),pg-77-91

Orbital lesions: surgical management within a multidisciplinary treatment.Orbital lesions: surgical management within a multidisciplinary treatment.Toniato G, , Skrap M. .

AIM: The aim of this review was to establish the timing and the AIM: The aim of this review was to establish the timing and the role of surgery within the multidisciplinary treatment of orbital role of surgery within the multidisciplinary treatment of orbital

lesions.lesions.

METHODS: It was retrospectively analysed a consecutive series of 50 orbital lesions, surgically METHODS: It was retrospectively analysed a consecutive series of 50 orbital lesions, surgically treated in the Department of Neurosurgery of the Udine University Hospital (Udine, Italy) treated in the Department of Neurosurgery of the Udine University Hospital (Udine, Italy)

between 1998 and 2007, and reviewed the current literature on this subject. RESULTS: This between 1998 and 2007, and reviewed the current literature on this subject. RESULTS: This series of 50 consecutive symptomatic patients surgically treated (32 total resection, 10 series of 50 consecutive symptomatic patients surgically treated (32 total resection, 10

subtotal removal and 8 biopsies ) was first evaluated, with the aim of comparing our subtotal removal and 8 biopsies ) was first evaluated, with the aim of comparing our experience with that of other groups. In this review, not only orbital lesions having the same experience with that of other groups. In this review, not only orbital lesions having the same

histology as those treated by the authors, but also most of the others reported in the literature histology as those treated by the authors, but also most of the others reported in the literature have been discussed, focusing particular attention on surgery.have been discussed, focusing particular attention on surgery.

. .

CONCLUSIONS: There is a wide variety of orbital lesions with CONCLUSIONS: There is a wide variety of orbital lesions with fragmentation of experience about correct diagnosis and fragmentation of experience about correct diagnosis and

treatment, also because of the different specialists who treat treatment, also because of the different specialists who treat orbital pathology. Consequently, in surgery different indications orbital pathology. Consequently, in surgery different indications may be considered for a total/subtotal resection or just a biopsy, may be considered for a total/subtotal resection or just a biopsy, and even the "wait and see" option is quite present. Considering and even the "wait and see" option is quite present. Considering that the surgery of the orbit is an affordable and not particularly that the surgery of the orbit is an affordable and not particularly risky choice for the patient, the authors think that it still remains risky choice for the patient, the authors think that it still remains

an important step in a combined therapeutical strategy.an important step in a combined therapeutical strategy.

Journal of orbit 2009 28(6):320-7

Total lateral orbitotomy

Kim JW, Yates BS, Goldberg RA

PURPOSE: The goal of this study was to evaluate the safety and efficacy of PURPOSE: The goal of this study was to evaluate the safety and efficacy of performing a total lateral orbitotomy (TLO) to enhance the surgical performing a total lateral orbitotomy (TLO) to enhance the surgical exposure of the deep orbit. exposure of the deep orbit. MATERIALS AND METHODS: Ten orbits of five fresh-MATERIALS AND METHODS: Ten orbits of five fresh-frozen cadaver heads were dissected to evaluate TLO surgical techniques. Through anfrozen cadaver heads were dissected to evaluate TLO surgical techniques. Through an eyelid approach, a bone flap extending from the supraorbital nerve to the infraorbital nerve was eyelid approach, a bone flap extending from the supraorbital nerve to the infraorbital nerve was removed to enhance exposure to the orbital apex. The surgical exposure was further augmented removed to enhance exposure to the orbital apex. The surgical exposure was further augmented by removing bone with the high-speed burr from the greater wing of sphenoid bone along the by removing bone with the high-speed burr from the greater wing of sphenoid bone along the deep lateral wall. Anatomic landmarks that identified various compartments within the lateral deep lateral wall. Anatomic landmarks that identified various compartments within the lateral wall and orbital roof were noted and measured. Five patients with posterior orbital tumors wall and orbital roof were noted and measured. Five patients with posterior orbital tumors underwent TLO utilizing extended bone flaps and their surgical results and clinical outcomes were underwent TLO utilizing extended bone flaps and their surgical results and clinical outcomes were recorded. RESULTS: The findings from this study demonstrate that the entire orbital rim from the recorded. RESULTS: The findings from this study demonstrate that the entire orbital rim from the supraorbital nerve to the infraorbital nerve may be removed without damaging critical supraorbital nerve to the infraorbital nerve may be removed without damaging critical neurovascular structures or creating a dural defect. Strategic removal of bone from the deep neurovascular structures or creating a dural defect. Strategic removal of bone from the deep lateral wall can further enhance the exposure to the orbital apex. Five patients with deep orbital lateral wall can further enhance the exposure to the orbital apex. Five patients with deep orbital lesions underwent TLO with excellent surgical outcomes.lesions underwent TLO with excellent surgical outcomes.

CONCLUSIONS: By utilizing TLO techniques in a patient CONCLUSIONS: By utilizing TLO techniques in a patient with a deep orbital lesion, the modern orbital surgeon with a deep orbital lesion, the modern orbital surgeon can access the orbital apex safely and predictably can access the orbital apex safely and predictably through an eyelid approach.through an eyelid approach.

JOURNAL OF RADIATION ONCOLOGY,DEC 2009,4;60JOURNAL OF RADIATION ONCOLOGY,DEC 2009,4;60

Radiation therapy in primary orbital lymphoma: a single institution Radiation therapy in primary orbital lymphoma: a single institution retrospective analysis.retrospective analysis.

De Cicco L, , Cella L, , Liuzzi R, , Solla R, , Farella A, , Punzo G, Tranfa F, Strianese , Tranfa F, Strianese D, Conson M, Bonavolontà G, Salvatore M,Pacelli R.D, Conson M, Bonavolontà G, Salvatore M,Pacelli R.

BACKGROUND: Primary orbital lymphoma is a rare disease that accounts BACKGROUND: Primary orbital lymphoma is a rare disease that accounts for 10% of all orbital tumors. Radiotherapy on the orbital cavity is the for 10% of all orbital tumors. Radiotherapy on the orbital cavity is the

treatment of choice for this unusual presentation of localized non-treatment of choice for this unusual presentation of localized non-Hodgkin's lymphoma (NHL). The aim of this study is to retrospectively Hodgkin's lymphoma (NHL). The aim of this study is to retrospectively evaluate the effectiveness and the toxicity of radiation treatment in evaluate the effectiveness and the toxicity of radiation treatment in

patients with primary orbital lymphoma. patients with primary orbital lymphoma. METHODS: Forty-seven consecutive patients having primary orbital lymphoma treated in our METHODS: Forty-seven consecutive patients having primary orbital lymphoma treated in our

department between May 1983 and September 2006 were investigated in a retrospective department between May 1983 and September 2006 were investigated in a retrospective study. Either 60Co gamma rays or 6 MV X rays were used to deliver daily fractions of 1.8 or study. Either 60Co gamma rays or 6 MV X rays were used to deliver daily fractions of 1.8 or 2.0 Gy, 5 times/week, with total doses ranging from 34.2 to 50 Gy. Forty-three patients had 2.0 Gy, 5 times/week, with total doses ranging from 34.2 to 50 Gy. Forty-three patients had

stage IE, three had stage II and one stage IV disease. Thirty-eight patients had marginal stage IE, three had stage II and one stage IV disease. Thirty-eight patients had marginal zone B-cell lymphoma, 5 diffuse large B cell lymphoma, 3 mantle cell lymphoma and 1 zone B-cell lymphoma, 5 diffuse large B cell lymphoma, 3 mantle cell lymphoma and 1

Burkitt lymphoma. Local control (LC), disease free survival (DFS), overall survival (OS) and Burkitt lymphoma. Local control (LC), disease free survival (DFS), overall survival (OS) and late side effects were evaluated in all patients. RESULTS: With a median follow up of 45 late side effects were evaluated in all patients. RESULTS: With a median follow up of 45

months, LC was obtained in 100% of patients. The estimated 5- and 7-year DFS rates were months, LC was obtained in 100% of patients. The estimated 5- and 7-year DFS rates were 75.8% and 55.3%, and the 5- and 7-year OS rates were 88.7% and 79.9% respectively. Acute 75.8% and 55.3%, and the 5- and 7-year OS rates were 88.7% and 79.9% respectively. Acute toxicity was minimal. Late toxicity such as cataract, keratitis, retinopathy and xerophthalmia toxicity was minimal. Late toxicity such as cataract, keratitis, retinopathy and xerophthalmia

occurred respectively in 12 (25.5%), 5 (10.6%), 1 (2.1%), and 9 (19.1%) patients.occurred respectively in 12 (25.5%), 5 (10.6%), 1 (2.1%), and 9 (19.1%) patients.

CONCLUSION: Radiotherapy is an effective and at the same time CONCLUSION: Radiotherapy is an effective and at the same time well tolerated treatment for primary orbital lymphoma. well tolerated treatment for primary orbital lymphoma.

Br J OphthalmolBr J Ophthalmol 2009;93:463-467   2009;93:463-467  Orbital recurrence of retinoblastoma following enucleationOrbital recurrence of retinoblastoma following enucleation

J W Kim, , V Kathpalia, , I J Dunkel, , R K Wong, , E Riedel, D H Abramson, D H Abramson

Background/aims: To determine the incidence, clinical presentation Background/aims: To determine the incidence, clinical presentation and histopathological profile of patients developing orbital and histopathological profile of patients developing orbital

recurrence following enucleation for retinoblastomarecurrence following enucleation for retinoblastoma . .Methods: A cohort of 1674 consecutive patients undergoing enucleations between Methods: A cohort of 1674 consecutive patients undergoing enucleations between

1914 and 2006 was retrospectively reviewed to identify cases of orbital recurrence. A 1914 and 2006 was retrospectively reviewed to identify cases of orbital recurrence. A detailed chart review of all identified patients with orbital recurrence following detailed chart review of all identified patients with orbital recurrence following

enucleation was performed. The main outcome measures were histopathological enucleation was performed. The main outcome measures were histopathological features of the enucleated globe, clinical presentation, status of metastatic disease features of the enucleated globe, clinical presentation, status of metastatic disease

and clinical outcomes of treatment at last follow-up.and clinical outcomes of treatment at last follow-up.Results: There were 71 cases of orbital recurrence identified in the study, for an Results: There were 71 cases of orbital recurrence identified in the study, for an

incidence of 4.2% (71 of 1674 cases). The diagnosis of orbital recurrence was made incidence of 4.2% (71 of 1674 cases). The diagnosis of orbital recurrence was made between 1 and 24 months after enucleation (mean 6 months), with 69 of the 71 between 1 and 24 months after enucleation (mean 6 months), with 69 of the 71

patients (97%) being diagnosed within the first 12 months. Over a follow-up period of patients (97%) being diagnosed within the first 12 months. Over a follow-up period of 3–208 months (mean 34.8 months), 60 of 71 patients developed metastatic disease 3–208 months (mean 34.8 months), 60 of 71 patients developed metastatic disease

(85%), and 53 of 71 patients died from metastatic retinoblastoma (75%). For the (85%), and 53 of 71 patients died from metastatic retinoblastoma (75%). For the subgroup of cases diagnosed as having orbital recurrences after 1984, 10 of 11 subgroup of cases diagnosed as having orbital recurrences after 1984, 10 of 11

patients (91%) are alive and well.patients (91%) are alive and well.

Conclusions: All patients undergoing enucleation for Conclusions: All patients undergoing enucleation for retinoblastoma need to be followed carefully for the first 2 years retinoblastoma need to be followed carefully for the first 2 years after surgery for the possibility of orbital relapse. The majority of after surgery for the possibility of orbital relapse. The majority of retinoblastoma patients with orbital tumour recurrence develop retinoblastoma patients with orbital tumour recurrence develop systemic metastatic disease, although mortalities appear to be systemic metastatic disease, although mortalities appear to be

improving in the modern era.improving in the modern era.

CONCLUSION• Common pediatric tumors are dermoids,capillary

hemangiomas,rhabdomyosarcomas.

• The top 3 adult tumors are lymphoid tumors ,cavernous hemangiomas,,meningiomas.

• Common presenting feature is PROPTOSIS.• The prognosis and outcome depends upon the

pathological diagnosis.

Thank you!!!