Orbital tumors are growths that develop in or spread to the eye socket, also called the orbit. Because the orbit contains the eye, optic nerve, eye muscles, nerves, blood vessels, fat, and connective tissue, even a benign tumor can cause serious symptoms such as eye bulging, double vision, pain, eyelid changes, pressure, restricted eye movement, or vision problems.
At Fante Eye & Face Center, patients from Denver, Greenwood Village, and surrounding Colorado communities receive orbital tumor evaluation and treatment planning from doctors with specialized training in orbital disease and oculofacial plastic surgery. Dr. Robert Fante is double board-certified and a fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery, while both Dr. Levitt and Dr. Huang are ASOPRS-trained surgeons and ASOPRS Candidate Members. This experience helps the team evaluate complex orbital concerns and coordinate care when imaging, biopsy, surgery, radiation, chemotherapy, or multidisciplinary treatment may be needed.
What Are Orbital Tumors?
The orbit is the bony socket in the face that contains the eye, along with muscles, nerves, fat, and connective tissue. The socket is widest at the front and narrows toward the back, where the optic nerve leaves the socket and enters the brain. An orbital tumor refers to any tumor located in the orbit. The orbit is a crowded space, so any tumor in it can cause serious symptoms and functional problems with the eye.
Orbital tumors can be primary, meaning they originate in the orbit. They can also be secondary, meaning that they invade the orbit from the adjacent paranasal sinuses or face.
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Or they can metastasize from cancer occurring elsewhere in the body, particularly the breast.
What Causes Orbital Tumors?
Orbital tumors can be benign or malignant. They can arise as primary tumors, originating in the eye socket, or they can be metastatic, originating elsewhere in the body which are then spread through the blood. Additionally, tumors can extend into the eye socket from adjacent tissues and structures, such as the eyelid skin, sinuses and lacrimal gland, which is the gland responsible for making the watery (aqueous) layer of the tear film.
Symptoms of an Orbital Tumor
An orbital tumor may present as a protruding eye, asymmetric fullness of the eyelids, droopiness the upper or lid, pain behind or around the eye or restriction in eye movement leading to double vision. Sometimes tumors are asymptomatic, and the exam findings are more subtle. With a thorough eye exam, an eye doctor may discover features that would warrant further workup for an orbital tumor. At that point, a referral to an oculofacial plastic specialist may be the next step. If there is concern for an orbital tumor, usually an imaging study, such as a CT scan or an MRI, will be arranged after your office visit.
How Are Orbital Tumors Diagnosed?
An eye doctor may first spot signs of an orbital tumor when performing a comprehensive eye exam. This allows the doctor to view the back of the eye where details may point to the presence of a tumor, and also to examine and measure many aspects of the eyelids, pupils, eye movements, and the health of all of the surrounding supportive tissues of the orbit.
Once a tumor is suspected, confirmation is achieved with either an MRI or a CT scan. These images will determine the location and size of the tumor. They will also usually show many details about the tumor that will narrow down the possible types of tissue that could be growing. However, a biopsy may be often necessary to establish a definitive diagnosis.
Treatment Options for Orbital Tumors
Treatment options vary with each case, but these are possible strategies:
- Observation — When there are few or no symptoms and the CT/MRI shows features of benign, slow-growing tumors, observation without treatment is often the best strategy. Later, if things change, one of the options below might be appropriate.
- Surgical options — Surgery to remove an orbital tumor is sometimes straightforward and can be accomplished with hidden incisions inside the eyelids or using natural creases near the eye. This type of surgery is simple, outpatient day surgery. Instead, other tumors may be more complex and often require a multidisciplinary team approach. Our doctors may work with oncologists, ear, nose, and throat surgeons, neurosurgeons, and craniofacial surgeons when necessary to achieve the best outcomes. Depending on the location and nature of the tumor, the surgeons may be able to approach the eye from the side or from above or below the eye. Reconstruction of the skull and orbit may be required as part of the treatment.
- X-ray therapy — Also known as external beam radiotherapy, this technique can shrink or eradicate certain types of tumors. The eyeball is protected using a special contact lens and side effects are usually minimal.
- Stereotactic radiosurgery — In this method, highly focused beams of radiation are directed onto the tumor to destroy it. It is used for malignant tumors that are not amenable to removal by surgery.
- Chemotherapy — Cancer-fighting drugs are delivered into the bloodstream or, sometimes, directly into the orbit, where they seek out and destroy cancer cells. Advances in chemotherapy have made it possible to be much more selective in the drug delivery, lessening whole-body toxicity.
When is Orbital Tumor Surgery Necessary?
Definitive surgery may not be the first course of treatment for an orbital tumor, depending on imaging features and exam findings. However, having a specific tissue diagnosis by undergoing an orbital biopsy may be the most important step in planning treatment.
Depending on the type of orbital tumor, stereotactic radiosurgery – in which highly focused beams of radiation are directed at the tumor – may be recommended. Chemotherapy, where cancer-fighting drugs are delivered into the bloodstream to seek out and destroy cancer cells could also be used. Interventional neuroradiology, which delivers tumor-fighting drugs directly to the site of certain tumors, may also be recommended.
But in many patients, surgery becomes the best treatment option. This is the case whether the tumor is benign or malignant. If left in place, the tumor can begin compressing the eye or optic nerve, affecting vision. It may cause a disfiguring protrusion of the eye. In either of these cases, surgery may be the best treatment option. The entire tumor may not be able to be removed in some cases but may be able to be reduced.
For these procedures, our doctors may work in tandem with a neurosurgeon or other specialist.
The goals of surgery to remove or debulk an orbital tumor are:
- To prevent a malignancy from progressing to a life-threatening stage
- To preserve vision
- To preserve the eye
- To alleviate the symptoms caused by the tumor
Goals of Orbital Tumor Surgery
When surgery is recommended, the goals may include removing or reducing the tumor, preserving vision, protecting the eye, relieving pressure or double vision, improving eye position, and obtaining tissue for diagnosis. In some cases, surgery may be combined with radiation, chemotherapy, or care from other specialists depending on the tumor type and location.
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Why Choose Fante Eye & Face Center for Orbital Tumor Repair?
Orbital tumor evaluation and treatment require specialized expertise because the orbit contains the eye, optic nerve, eye muscles, nerves, blood vessels, fat, and surrounding support structures. Treatment planning must consider not only tumor removal or diagnosis, but also vision, eye movement, eyelid position, comfort, appearance, and long-term function.
At Fante Eye & Face Center, patients are treated by doctors with advanced training in oculofacial plastic and reconstructive surgery, including orbital disease and surgery. The team can evaluate symptoms, coordinate imaging, perform or recommend biopsy when needed, and help determine whether observation, surgery, radiation, chemotherapy, or multidisciplinary care is most appropriate.
When tumors are complex, our doctors may coordinate with oncologists, ear, nose, and throat surgeons, neurosurgeons, radiation oncologists, and other specialists to provide safe, comprehensive care.
Orbital Tumor Consultation in Denver & Greenwood Village, CO
If you have been diagnosed with an orbital tumor or are experiencing eye bulging, double vision, eye pressure, eyelid changes, restricted eye movement, or vision concerns, Fante Eye & Face Center can help evaluate your condition and treatment options. During your consultation, our doctors will review your symptoms, examine the eye and orbit, discuss imaging or biopsy when needed, and explain whether observation, surgery, radiation, chemotherapy, or multidisciplinary care may be appropriate.
To book a consultation with Fante Eye & Face Center in Denver, CO, serving patients from Greenwood Village, Castle Pines and the surrounding communities, call (303) 839-1616 today.