Spectrum of orbital tumors in a tertiary eye care centre

Prashant, Raphael (2006) Spectrum of orbital tumors in a tertiary eye care centre. Masters thesis, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai.

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Abstract

INTRODUCTION: The orbit contains variety of tissues including bone, extra ocular muscles, peripheral nerves, cranial nerves, fibro vascular adipose tissue and cartilage and a variety of systemic disorders may manifest in the orbit of which orbital tumors constitute the major category. Diseases of the orbit create some of the most complex and perplexing problems in ophthalmology The initial clinical evaluation of the patient with an orbital lesion is frequently inconclusive .After taking the patient’s history and then examining the patient there invariably remains enough uncertainties to require consultation with other specialists and referral for radiological and ultrasonographic studies. Very often, a desirable end result of the workup is the localization of the lesion to a particular area of the orbit, thereby facilitating the surgical exposure of the lesion and permitting its excision. Such a complex subject deserves a precise table of organization; unfortunately none exists. The small confines of the orbit and the anterior location of the eye ball limit direct observation or palpation of orbital tumors. Even knowledge of the approximate size, location and consistency of the lesion is not effective means of sorting out the various lesions of the orbit. Additional information regarding the direction degree and rate of progression of proptosis and other information does not facilitate the formulation of a workable classification. Classifications of the orbital disease derived from the use of ultrasonography and computerized tomography have become very helpful; however such data are usually not available at the initial evaluation. Perhaps the most commonly used classification is one based on the review of histopathologic material. The reported incidence of orbital tumors varies widely from series to series depending on the material studied .One finds a considerable difference in the incidence of various lesions in series derived from biopsy material as compared with those that include clinical diagnosis without histopathological verification.Series from large ophthalmic departments have inherent bias depending on the referral patterns special interests of the ophthalmologist and other factors. This study intends to study the spectrum of orbital tumors in a tertiary eye care centre. AIMS AND OBJECTIVES : The aims of the study is to 1. Study the demographic distribution of orbital tumors –age wise, sex wise and state wise. 2. Study the presenting complaints, the presenting eye and the duration of the symptoms. 3. Study the history of the associated symptoms and the presence of past and family history 4. Study the clinical features like the visual acuity, puppilary reactions and fundus of the affected eye. 5. Study the laterality of the tumor, type of proptosis, and degree of proptosis. 6. Study the associated clinical features of the affected eye. 7. Study the type of investigative modality used in the diagnosis of the tumor. 8. Study the treatment modality used in the treatment of the tumor. 9. Study the classification of the tumor, the nature of the tumor and type of tumor. 10. To compare the results got with that of international studies. PATIENTS AND METHODOLOGY: This prospective descriptive study has enrolled patients with orbital tumors, coming to the orbit clinic of a tertiary eye care centre from September 2003 to March 2005. Any case of orbital tumor that presented for the first time to the hospital was included in the study. Follow up cases were excluded from the study thereby avoiding repetition. The orbital tumors were diagnosed based on the proforma given below. The diagnosis was based on clinical history and eye examination .Laboratory investigations as well as radiological investigations like X-ray, USG, CT scan were undergone by the patient as required. Histopathological examination using light microscopic examination of H and E stained slides after fixation, paraffin embedding and sectioning were done. Treatment of orbital tumors was also studied. This study includes orbital tumors diagnosed both by clinical methods and by investigations. DISCUSSION: A spectrum of tumors can involve the orbit .Several publications have addressed the incidence of space occupying lesions in the orbit. However the reported incidence of orbital lesions show great variation .Most reported series of the frequency of orbital tumors are biased by various factors like specialty of the reviewer, histopathological confirmed lesions, age range of patients and geographic area of the patients. The present study differs from the other studies in that it includes patients seen in a tertiary care centre and also on clinical and pathologically proven cases and so reflects the true incidence of orbital tumors seen in ophthalmic practices Our study is compared to the five major studies done by Shield, Kennedy, Rootman, Henderson and Wilson. Robert Kennedy’s series was based on the tumor registry, Shields on the pathology specimens, Henderson summarized his clinical experience, Rootman tabulated his orbital practice and Wilson summarized the orbital lesions submitted to them. This study includes tumors encountered in a tertiary eye care centre and includes both the clinically and the pathologically proven cases. CONCLUSION: The age wise distribution in the study showed that the most common age group was the 40-59 year age group with the mean age being 39.6 years In this study females were more commonly involved than males In this study the most common state from where the patients presented was Tamil nadu and the second being from Kerala In this study the left eye was more commonly involved than the right eye The most common presenting symptom was proptosis followed by the presence of a mass. All patients who had the disease before had taken treatment for it before. Family history was positive only in 2% of cases. The visual acuity was between 6/6 -6/18 in most of the patients The eye lids and the conjunctiva were normal in most of the cases. The most common presentation in the eyelids were ptosis and the chemosis and congestion and chemosis were present in all the other cases .Pupil reaction was normal in most of the cases and the fundus was normal in most of the cases examined. Unilateral presentation was more common than bilateral and eccentric proptosis was more common than axial proptosis Mass felt, warmth ,tenderness ,resistance to retropulsion ,pulsation ,variation with posture and valsalva manouvre and bruit were not felt in most of the cases .Ocular movements were restricted in most of the cases. Histopathological examination and CT scan were the two most common investigations done Surgery was the most common modality of treatment followed by a combination of surgery and radiotherapy. Benign tumors were more common than the malignant ones. Vascular, neural and epithelial tumors were the most common tumors encountered. The most common primary tumors were malignant lymphoma ,cavernous hemangioma, neurofibroma and adenoid cystic carcinoma.

Item Type: Thesis (Masters)
Uncontrolled Keywords: orbital tumors; tertiary eye care centre
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 15 Feb 2018 06:38
Last Modified: 15 Feb 2018 06:38
URI: http://repository-tnmgrmu.ac.in/id/eprint/5708

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