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. 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.
What Are The 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 oculoplastic specialist, such as Dr. Fante, is 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.
Diagnosing Orbital Tumors
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 show characteristics of benign, slow-growing tumors, observation with no 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. Dr. Fante 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 the 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 – where highly focused beams of radiation are directed at the tumor – could be suggested. 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, Dr. Fante often work in tandem with a neurosurgeon or other specialist, as needed.
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
What Are The Advantages of Having Surgery to Remove an Orbital Tumor?
Surgery demands a high level of skill and experience, but it is often the best treatment option for orbital tumors. For instance, benign tumors won’t respond to treatments such as chemotherapy or radiation, and since most orbital tumors are benign, surgery is the best way forward. Even though these tumors may not be cancerous, they can grow and displace the eye, causing potential vision loss, or it may cause the eye to bulge forward, creating problems closing the eye. If the tumor is causing disfiguration, surgery may be the only way to address it effectively.
Even with cancerous tumors, surgery is often the best option for the orbital area. This may sometimes be coupled with radiation or chemotherapy.
Does Orbital Tumor Surgery Require Anesthesia?
Yes. Patients are under general anesthesia for these involved surgeries. The procedure can take from 1 to 6 hours, depending on the route of access.
Is Orbital Tumor Surgery Safe?
There are risks with these intricate procedures, but there is usually greater risk when orbital tumors are left untreated. They will likely grow and endanger the patient’s eye and vision.
The biggest concern during or after orbital surgery is that vision can be negatively affected due to trauma during the surgery or bleeding or swelling after the surgery. Your vision will be closely assessed and monitored several times immediately after the procedure.
The orbital area has other important structures, such as nerves and blood vessels, so there is also the risk of damage to those structures. Having surgery with a board certified oculoplastic surgeon who is highly trained in orbital disease and surgery is the best option.
Is Stereotactic Radiosurgery a Safe Treatment for Orbital Tumors?
There is risk with both stereotactic radiosurgery and surgery for patients with orbital tumors. Where surgical access to the tumor is achievable and full removal is possible, surgery would be preferred. When it is not, radiotherapy may be the first choice of treatment. A benign tumor will not respond to stereotactic radiosurgery.
These are the possible risks involved with stereotactic radiosurgery:
- Dry eye(s)
- Skin problems, such as scarring and/or depigmentation
- Hair loss in the treatment area, including loss of eyelashes
Long-term risks may include changes to the vision. Speak to your radiation oncologist for specific risks, as all cases are different and will require different therapy.
What is Recovery From Orbital Surgery Like?
Every surgery is unique, so recovery is variable. Following simpler types of orbital surgery, patients will be able to go home the same day and instructions will include use of ice, antibiotics, and eyedrops. Bruising, swelling and temporary numbness of the area are common, but severe pain is not. Other patients who have complex surgery may stay in the hospital from one to three days. Total recovery will last up to six months, although most of the healing occurs in the first six weeks.
What Are The Prognosis And Risks Involved With Orbital Tumor Treatment?
For benign, non-cancerous tumors, the prognosis after treatment is usually excellent and the vast majority of people will experience complete recovery with normal function and appearance.
Many malignant tumors can be cured using surgery, radiation and/or chemotherapy. Of course, the pathological diagnosis (from biopsy) and cancer staging will determine the recommended treatment and the likelihood of success in many cases. Depending on the size, location, and type of malignant tumor, complete return to normal function and appearance may or may not be possible.
The risks involved with surgery include, but are not limited, to: bleeding, infection, an asymmetric or unbalanced appearance, scarring, difficulty closing the eyes, double vision, tearing or dry eye problems, inability to wear contact lenses, numbness and/or tingling near the eye or on the face, and possible vision loss.
“Dear Dr. Fante, I just wanted to take a moment to express our collective gratitude to you and your wonderful, compassionate staff. As you’re well aware, this was a very difficult and frightening time for all of us. Aside from my mother’s medical issues, my family was dealt the sad news of the passing of my grandmother. I write this to further contextualize how you and your staff provided our family a calming and steady anchor during this difficult time. For that and for the many kindnesses your showed us, we will always be grateful. Thank you so very much.”