Eye and Orbit Tumors: These tumors can develop from infancy and may appear suddenly or gradually in later decades. Most of these tumors are superficial and can easily be diagnosed through external appearance, palpation, radiography, or CT scan. Drooping eyelids are significantly noticeable, and vision functions are impaired. These tumors do not invade surrounding tissues. Types of these tumors include dermoid cysts, mucoceles, hemangiomas, lymphangiomas, lacrimal duct tumors, and neurofibromas.
To prevent recurrence, complete surgical removal of these tumors is performed. Sometimes, tumor removal is difficult due to involvement of parts of the orbital bones, such as in deep dermoid cysts that require bone separation. In benign deep tumors that are intertwined with other orbital structures, such as optic nerve meningiomas, subtotal removal is used. Complete tumor removal can threaten vision function.
Benign Eyelid Tumors: These tumors vary in type and are more common with increasing age. They may be non-pigmented at birth and darken in adolescence, or never become pigmented. Hemangiomas are capillary tumors that appear as red, superficial lesions (previously called strawberry angiomas) or deeper blue and purple lesions. Milia are small, raised, white cysts on the eyelids that occur in multiples.
Xanthelasma is a tumor caused by fat deposits, appearing yellow, and occurs on both eyelids due to skin aging or lipid disorders. Molluscum is a type of contagious lesion with symmetrical, flat growth, typically on the eyelid margins, and is caused by a viral agent. If the lesion grows into the conjunctival sac, it can lead to conjunctivitis and corneal inflammation.
Treatment for benign congenital eyelid lesions is rarely indicated unless vision is affected. Corticosteroid injection into hemangiomas usually has therapeutic effects, but surgical removal is also performed. Benign eyelid tumors typically do not affect vision but may have aesthetic implications. Surgical removal or electrocautery is mostly done for cosmetic reasons, except in the case of contagious molluscum, where surgery is aimed at preventing subsequent infections.
Benign Conjunctival Tumors: Conjunctival nevi are benign congenital neoplasms that are usually brown, flat, and slightly raised, becoming pigmented during childhood and adolescence. These lesions should be distinguished from pigmented melanosis, which occurs in middle age and can turn into melanoma. Dermoid cysts, which contain sebum and keratin, are congenital and sometimes seen in the conjunctiva. Dermolipomas are a type of congenital tumor that is round with smooth borders, located in the conjunctiva near the external canthus. Papillomas are usually soft with irregular surfaces and grow on the eyelid margins. Treatment involves surgical removal.
Malignant Orbital Tumors: Rhabdomyosarcoma is the most common primary ocular tumor in children but can also occur in adults. Symptoms and signs of this tumor include sudden, painless ptosis in one eye, followed by eyelid swelling, conjunctival ecchymosis, and abnormal eye movements. CT or MRI images of these tumors determine size, shape, location, disease stage, and bone destruction, which are helpful for radiation therapy planning, if needed. The most common site for metastasis of this tumor is the lungs.
Treatment for malignant primary ocular tumors includes three phases: surgery, radiation therapy, and adjunct chemotherapy. Involvement of ocular structures determines the type of surgery. Surgical treatment usually involves enucleation, so the psychological needs of the patient and their family are important in planning the therapeutic approach.
Malignant Eyelid Tumors: Basal cell carcinoma is the most common malignant eyelid tumor. Squamous cell carcinoma is less common but is the second most frequent malignant tumor. Malignant melanoma is rare. Malignant eyelid tumors are more common in individuals with light skin who have been exposed to prolonged and continuous sunlight. Basal cell carcinoma appears as painless nodules that may ulcerate. The lesion is invasive and spreads to surrounding tissues but grows slowly and does not metastasize. It is commonly found on the lower eyelid near the internal angle with a white, shiny border. Early stages can be mistaken for basal cell carcinoma as this tumor also grows slowly and is painless. This tumor tends to form ulcers and invade surrounding tissues but can metastasize to regional lymph nodes. Malignant melanoma may not be pigmented and can arise from existing moles, spreading to surrounding tissues and metastasizing to other organs.
Treatment generally involves surgery followed by reconstruction using skin grafts if wide surgical removal is necessary. The eye socket and the site from which the graft is taken may be affected by bleeding. Graft sites include the oral mucosa, thigh, or abdomen. The patient is referred to an oncologist for radiation therapy evaluation and metastasis monitoring. Early diagnosis and surgical measures are key determinants for the prognosis of this disease. These conditions are life-threatening, and since surgery affects the patient’s appearance, emotional support is crucial in their nursing care.
Malignant Conjunctival Tumors: Conjunctival carcinoma usually occurs in visible areas of the conjunctiva. Common lesions are often white due to the formation of gelatinous keratin. They grow slowly, and deep invasion and metastasis are rare. Melanoma is rare but can arise from an existing mole or acquired melanosis during middle age. Squamous cell carcinoma is also rare but aggressive.
Treatment for these tumors is surgical. Some benign tumors and more malignant tumors may recur. After surgery and tumor removal, radiation therapy and serum treatment are used to prevent recurrence. Large surgical incisions due to deep tumor invasion may result in cosmetic deformities of the face.
Malignant Eye Tumors: Ocular melanoma is a rare, malignant choroidal tumor that is usually detected during retina examinations. In its early stages, it may be mistaken for a mole. The patient must be thoroughly examined for metastasis to other organs such as the lungs, liver, and breasts. Fundus photography, fluorescein angiography, and ultrasound are performed. Diagnosis is confirmed after tumor removal through biopsy.
These tumors are classified based on their borders (apical height and basal diameter) as small, medium, and large. Small tumors require monitoring, while medium and large tumors require treatment, including radiation therapy and enucleation or both. Radiation therapy can be performed in two ways: either by delivering repeated doses of external radiation over several days or by implanting a small radioactive plaque.
(Wishing you a speedy recovery)
Farvardin Surgery Center