【摘要】 To study the pattern of presentation and to highlight the common causes of primary benign orbital lesions.A prospective study conducted at the Department of Ophthalmology of Jinnah Postgraduate Medical Centre Karachi from July 1997 to August 2001 and then from September 2001 to date (Continued) at the Department of Ophthalmology of Chandka Medical College & Hospital Larkana. Only patients with primary benign orbital lesions were included in this study. All the patients were admitted in eye ward from the out patients department. The diagnosis of the disease was based on the presentation, clinical examination, investigations and histopathology of excised mass. A total of 68 patients were included in this study. The age range was from 2 months to 60 years. Out of 68, 27 (39.7%) patients were male and 41 (60.3%) were female. The left orbit was involved in 35 (51.5%) and right orbit was involved in 33 (48.5%).The analysis of 68 cases of primary benign orbital lesion revealed that superficial capillary hemangiomas of the eye lid were the most common lesion 26 (38.2%) followed by deep orbital cavernous hemangiomas 5 (7.4%), lymphangiomas 5 (7.4%), orbital varices 4 (5.9%), gliomas 7 (10.3%), meningiomas 5 (7.4%), neurofibromas 5 (7.4%), neurofibromatosis 4 (5.9%), schwannomas 2 (2.9%), and pleomorphic adenoma (benign mixed cell tumor) of lacrimal gland 5 (7.4%) cases.Early arrival, careful evaluation, proper diagnosis and treatment can prevent the patient from visual and life threatening complications.
【关键词】 benign orbital lesion primary diagnosis
INTRODUCTION
The orbital space occupying lesions may cause proptosis, that is displacement of the globe beyond the orbital margins, away from location of the lesion, with the patient looking straight a head. The lesion is usually unilateral, but may be bilateral[1]. The underlying etiology may be: congenital or acquired, inflammation (infective/non infective); tumor (benign/malignant); trauma (blunt/penetrating); degenerative.
The tumors arising from the orbital contents and eyeball are called as primary orbital tumors, from the tissues around the orbit ( Paranasalsinuses, meninges, brain, bone) are called as secondary orbital tumors and initially from distant body organs and then involve the orbit via hemopoietic reticuloendothelial system (RES) or lymphatic system are called as metastatic orbital tumors[2]. The tumor may be benign or malignant and may display infiltrative or non infiltrative behavior. Clinically, the benign noninfiltrative mass is usually associated with mass effect without destruction or entrapment. In contrast, a malignant infiltrative mass is usually associated with evidence of functional damage or entrapment. On investigation, both types are characterized by mass effect with displacement; however, malignant infiltrative lesion may have irregular margins, entrapped structures, and destruction of bone, as opposed to smooth, regular, noninfiltrative benign mass[3].
The symptoms and signs of the orbital lesions are manifested by displacement of the globe (axial; nonaxial), local pain, redness, swelling, decreasing vision, diplopia, congestion and edema of the eye lids and conjunctiva and exposure keratopathy. The fundus examination may shows optic disc edema/pallor/congestion; venous dilatation/tortuosity; choroidal folds and striae in the posterior fundus[4].
MATERIALS AND METHODS
A prospective study from July 1997 till to date (continued) was carried out at Ophthalmology Department of Jinnah Postgraduate Medical Centre, Karachi and Ophthalmology Department of Chandka Medical College Hospital Larkana combinedly to analyze the primary benign orbital lesions. All the patients were admitted in the eye ward from eye out patients department. After getting personal data and detailed history on the specific proforma all these patients were thoroughly examined (Ophthalmic, General and Systemic), investigated and treated properly. The diagnosis of disease was based on symptoms, signs, investigations and histopathology of excised mass. Only patients with primary benign orbital lesions were included in this study. To rule out site of origin and underlying cause of orbital lesion, various noninvasive and invasive investigations (where ever indicated) were performed.
For example, blood cell count and morphology (to rule out leukemia/lymphoma); Xrayorbits, skull, chest, pelvis(to rule out primary/secondary involvement of soft tissues and bones); ultrasound abdomen.(to rule out metastasis); ocular BScan.(to rule out status of eye globe); CT scan/MRI to obtain three dimensional view of involved mass/organ with its site/size/shape/surface/density (to rule out local tissue damage and extension); incisional/excisional biopsy of affected mass/organ/lymph node(to confirm the histopathologic diagnosis).
Table 1 Analysis of primary benign orbital lesions（略）
Figure 1 Superficial capillary haemangioma of eye lid （略）
A: Six months old baby with soft reddish, fleshy mass involving whole of the left upper eye lid. The left eyeball not visible; B: The same patient after local injection of steroids. Total three injections were given with interval of 2 months
RESULTS
The registered total number of patients with any of orbital lesions was 615, out of which 68 (11.1%) benign orbital lesions were picked up. The analysis of primary benign orbital lesions was shown in Table 1, and their treatment, postoperative complications were shown in Table 2 and 3, respectively.
DISCUSSION
Hamartomas means tumor like malformations result from developmental errors of vasoformative tissues. These, unlike true neoplasms, lack the power of unlimited, disproportionate growth, but become stationary after reaching their maximum size, often at a time when bodily growth stops. Therefore, hemangiomas and lymphangiomas are considered as hamartomas. Like the study of Douglas et al [5], we had also noticed hemangiomas more in females 21 (67.7%) cases than in males 10 (32.2%) out of 31 cases, and were characteristically unilateral. In our study the most common type of primary benign orbital lesion was hemangioma. It was of two types: capillary and cavernous. The superficial capillary hemangioma was common in children 26 cases and cavernous in adults 5 cases[6]. Vascular tumors in children are more compressible than those in adults, as connective tissues capsule does not develops till later in life[7]. All patients of superfical capillary hemangioma were presented with reddish fleshly growth with strawberry appearance, increasing in size with crying and cough, occupying the part or whole of the upper or lower eye lid since birth. Among these, 8 lesions were large enough to obstruct visual axis (Figure 1) and 7 lesions bleed frequently, which were treated with intralesion local steroid injections, and rest of small lesions were left as such (Figure 2). In our study, there were 5 cases (3 female and 2 male) of deep orbital cavernous hemangiomas. They were presented at the age of 3550 years with axial proptosis since 12 years. The proptosis was nonpulsatile, non tender, slightly reducible. All underwent for surgical resection of tumor through lateral orbitotomy and histopathology of mass confirmed the cavernous hemangioma (Figure 2).
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