Orbital tumors relatively uncommon in children and can be presented with inHints to easily suspect pediatric orbital tumors:
•disrupted ocular motility
•pain on eye movement
•pain in the orbit
•RAPD if the optic nerve is compromised
Children who present with symptoms of pain and redness mostly inflammation (preseptal cellulitis or orbital cellulitis)
Rarely does pain and redness indicate an underlying malignancy. The most common painful malignancies (lacrimal gland malignancy and other malignancies that invade the perineural region) .
Some benign conditions can cause pain,(rapid proptosis from hemorrhagic lymphangioma).
Most orbital tumors do not produce pain. They present quietly behind the child’s eye with symptoms of proptosis, eyelid retraction, or swollen eyelid.
In infants, the most common tumor is capillary hemangioma of infancy or orbital dermoid. They can be differentiated based on magnetic resonance imaging features showing the vascular enhancing mass of hemangioma versus the cystic mass with no internal enhancement of dermoid cysts.
pre-teen years, the most common orbital tumors (pseudotumor, orbital myositis, lymphangioma ,and rhabdomyosarcoma, optic nerve glioma ) and can be differentiated based on imaging features, with pseudotumor showing enhancement of the orbit diffusely and with myositis enhancement of the muscle.
Lymphangioma is multicystic mass with fluid levels on imaging.
Rhabdomyosarcoma is solid mass with diffuse enhancement.
Optic nerve glioma fusiform enlargement and enhancement of optic nerve
The management of Hints to easily suspect pediatric orbital tumors
•Inflammatory conditions are managed with corticosteroids and antimicrobials if needed
•lymphangioma with resection or drainage of hemorrhage
•Rhabdomyosarcoma with wide surgical resection followed by chemotherapy and radiotherapy.
•ON glioma surgery and radiation are options
•capillary hemangioma ( steroid and beta blockers)
•dermoid ( excision)
NB:Metastatic neuroblastoma to the orbit may present with proptosis and periorbital and eyelid ecchymosis, and can be confused with ecchymosis secondary to orbital trauma.
Hints to easily suspect pediatric orbital tumors PowerPoint presentation:
1. ORBITAL TUMOURSORBITAL TUMOURS
2. LocationLocation A lesion in the orbit? Decide whether it is an ocular lesion OR a non-ocular lesion, i.e. is it involving the globe or involving the structures outside the globe. If it is a non-ocular lesion, see the lesion is involving which space.
3. INTRA ORBITAL SPACES Intra-orbital pathology which is non-ocular is either in the Intraconal conal extraconal space.
4. Conal space The ocular muscles within the orbit form a muscle-cone. These are connected via the annulus of Zin, which is a fibrous connective tissue sheet. The muscles and fascia together form the conal space.
5. Intraconal space within the muscle cone. bounded by the cone formed by the extraocular muscles.
6. Extraconal space The extraconal space is the area outside the muscle cone.
7. ORBITAL PATHOLOGIESORBITAL PATHOLOGIES Intraconal space pathology: Venous vascular malformation Capillary hemangioma Optic nerve lesions ◦ Optic neuritis ◦ Optic nerve glioma ◦ Optic nerve meningioma
8. Venous dilatation ◦ Carotid Cavernous Fistula ◦ Varices Schwannoma of 3rd, 4th and 6th cranial nerve
9. Conal space pathology: Thyroid eye disease Pseudotumor Enlargement of the extra-ocular muscles by glycogen storage disease Lymphoma Rhabdomyosarcoma
10. Extraconal space pathology: Abscess due to sinusitis Schwannoma of the trigeminal nerve Dermoid Bone lesions, Fibrous dysplasia of the sphenoid wing Metastases Diseases of the orbital appendages
11. ORBITAL LYMPHOMA Presents in middle age with painless orbital swelling progressing to proptosis. Orbital lymphoma is of the B-cell variety (NHL); Hodgkins disease of the orbit is rare.
12. Site of involvement Any structure in the orbit may be affected. The lacrimal gland is involved most frequently, then the conal/intraconal compartment. Superior rectus is the commonest extra-ocular muscle involved.
13. RADIOLOGIC FEATURES: CT findings: a wide range of radiological findings. It may be a well-defined hyperdense enhancing mass OR
14. Can produce diffuse infiltration leading to destruction of the normal anatomical architecture. Molds to the contour of the orbit without bone destruction, unless it is very aggressive.
Hints to easily suspect pediatric orbital tumors Videos:
Orbit Intraconal Lesions V4b
Hints to easily suspect pediatric orbital tumors