Orbit pathology

1. OPTOM FASLU MUHAMMED

2.  Orbital tumours` include tumour like
conditions such as inflammatory lesions,
cysts and lymphoid hyperplasia
 A 70% of all orbital tumours originate from
orbital tissues while 30% invade the orbit
from adjacent structures or metastasis from
distant primary foci.

3.  Space occupying lesions, involving the orbit,
produce symptoms and signs by
compression, infiltration and or infarction of
orbital structures .
 In the final analysis, the clinical presentation
will result from displacement and or
dysfunction of the globe, optic nerve,
oculomotor nerves and blood vessels.

4.  It is defined as forward displacement of the
eyeball beyond the orbital margins.
 It is a common feature of all orbital tumours,
though it`s degree may vary.
 Those within the muscular cone usually
produce axial proptosis.
 Those outside the muscular cone tend to
push the eye outwards and in a direction
opposite to that lesion (eccentric)

5.  Optic nerve involvement may result in :
a) Progressive visual loss associated with
edema of disc
- in many patients visual loss may be
minimal and of delayed onset . In such
cases testing of colour vision may reveal
subtle defects.
a) Unilateral transient visual loss which may
occur in certain positions of gaze and clears
when the direction is changed

6. c) A specific triad may develop in chronic
compression of the optic nerve
1. Loss of vision
2. Swelling of disc which resolves into optic
atrophy
3. Appearance of optociliary shunt veins

7.  The tumours located in the orbital apex may
involve oculomotor nerves in early stage
even before causing proptosis.
 Some tumours may involve one or two
muscles, till late in the disease .
 Diplopia produce by orbital masses may be
neurogenic or myogenic and rarely it may be
a combination of both.

8.  The mechanical restoration of ocular mobility
can be confirmed by performing certain
tests.
 Forced duction or traction test
 IOP increases on looking in the direction of
gaze limitation

9.  Most of the lesions are painless
 Pain is more frequent with malignant
tumours.
 Lesions that involve cavernous sinuses and
paranasal sinuses are usually painful.

10.  Abnormalities can occur depending upon the
involvement of the parasympathetic or
sympathetic nerves, but this is often marked
by involvement of oculomotor nerve palsy.
 The presence of Marcus Gunn pupil is
suggestive of optic nerve compression.

11. DEVELOPMENTAL LESIONS

12.  Pulsating exophthalmos results due to
defective development of sphenoid wing and
roof of the orbit.

13.  These tumours result from embryonic
ectodermal sequesrations.
 These are rare , found inside the orbit, and
most of them are located in the periorbital
region.
 Dermoids and epidermiods have the same
histological features as seen elsewhere in
the body.
 They are invariably benign and can be
excised with ease

15.  It is a type of congenital lesion composed of
tissues normal to the location.
 One type of the tissue may be predominantly
seen such as vascular tissue.

16.  It is a non neoplastic disease of the bone
that affects children and young adults.
 Craniofacial fibrous dysplasia is a benign
condition forming about 3% of all bone
tumours.
 Dysplasia of frontal, sphenoid, ethmoid,
zygomatic and maxillary bones may involve
the orbit causing visual symptoms.
 These lesions is usually painless

17. INFLAMMATORY LESIONS

18.  Orbital cellulitis can remain as a diffuse
inflammation or progress to loculation to form
an abscess.
 There is usually profound disturbance of
oculomotor function , pain and constitutional
symptoms.
 Occasionally , the abscess may become
chronic and lesion may manifest like benign
space occupying lesion.
 Pathology reveals diffuse suppurative
inflammation composed of neutrophils.

20.  Orbital pseudo tumour or idiopathic
inflammatory pseudo tumour of the orbit is
the most common cause of an intra orbital
mass.
 Pseudo tumour can occur throughout the
orbit from the region of lacrimal gland to the
orbital apex and thus produce varied clinical
presentations.

21.  Swelling or puffiness of the eyelids, proptosis,
orbital pain, restricted ocular movements, diplopia,
chemosis and redness.
 Most cases are unilateral, although both sides may
be involved occasionally.
 The condition typically affects individuals between
40 and 50 years; however, age is no bar.
 Spontaneous remissions after a few weeks are
known in pseudo tumour.
 Recurrences are also common. In some patients
severe prolonged inflammation may cause
progressive fibrosis of the orbital tissues leading to
a frozen orbit with visual impairment.

23. Orbital infections
1. Aspergillosis
2. Tuberculosis
3. cysticercosis

24.  It is a fungal disease caused by aspergillus
fumigatus , the most common species.
 Infection usually begins in the sinuses and
erodes into the orbital cavity.
 The organisms have a tendency to invade
vessels and cause ischemic necrosis.
 A necrotizing reaction destroys muscles,
bone and soft tissue

25.  patients are present with Pain and proptosis
 Necrotic areas with black eschar formation
may be seen on the mucosa of palate,
turbinates and nasal septum and skin of
eyelids
 Diagnosis is made clinically and confirmed
by biopsy of the involved area and finding of
nonseptate broad branching hyphae.

27.  Orbital tuberculosis is rare
 Etiology shows caseating and non caseating
coalescing granulomas.
 There may be variable degree of fibrosis.

28.  Cysticercosis of orbit is very rare
 They shows fibro cellular reaction with
pallisading histiocytes around the parasite

29.  Faciomaxillary injuries may involve the orbit
by means of fractures of the orbital walls or
haemorrhages within the orbit.
 Blowout fractures’ mainly involve orbital floor
and medial wall.

30. NEOPLASTIC LESION

31. 1.Cavernous haemangioma
2.Capillary haemangioma
3.Lymphangioma
4.Meningiomas

32.  It is the commonest benign orbital tumour
among adults.
 The tumour is usually located in the retrobulbar
muscle cone. So, it presents as a slowly
progressing unilateral axial proptosis in the
second to fourth decade.
 It may occasionally compress the optic nerve
without causing proptosis.
 Surgical excision of the tumour is undertaken
since the tumour is well encapsulated, complete
removal is generally possible.

33.  It is generally single,bright red and smooth.
 A benign tumour manifests usually in the first
five years of life and tend to regress
thereafter
 Histologically , capillaries of small size are
found closely packed with no smooth muscle
in between.

34.  It is an uncommon tumour presenting with
slowly progressive proptosis in a young
person.
 It often enlarges because of spontaneous
bleed within the vascular spaces, leading to
formation of ‘chocolate cysts’ which may
regress spontaneously.

35.  They are three types based on their origin
1. Intracranial meningiomas
- Meningiomas of middle cranial fossa
especially those of shenoid ridge are
notorious to cause proptosis
- Meningiomas of the anterior cranial fossa
may invade the orbital roof.
- Ectopic meningiomas from frontal sinus
may encroach into the orbit

36. 2.Primary intraorbital meningiomas
- Are rare tumours which arise from the optic
nerve.
- This is most difficult to treat and has been
called the impossible meningioma.
3.Those which have no apparent connection
with optic nerve are occasionally found in the
orbit

37. 1. Rhabdomyosarcoma
2. Adenoid cystic carcinoma
3. Lymphoma
4. Histiocytoma
5. Metastasis
6. Optic glioma

38.  It is a highly malignant tumour of the orbit
arising from the extraocular muscles.
 It is the most common primary orbital tumour
among children, usually occurring below the
age of 15 years (90%).
 It classically presents as rapidly progressive
proptosis of sudden onset in a child of 7-8
years.
 Massive proptosis due to rhabdomyosarcoma
located in the superonasal quadrant
(mimmicking acute inflammatory process).

39.  Histologically, the tumours are of three types
 1.Embyonal 2.adult pleomorphic 3.alveolar
 Embryonal rhabdomyosarcoma is the most
common type of malignant tumour.
 They are round, oval or stellate rhabdo
myosarcoma with mitosis in loose syncitium.
 Cells contain dense eosinophilic cytoplasm
with striations.

40.  It occurs in adults of either sex in the fourth
decade of life.
 The lesion is remorselessly progressive ,
invading the adjacent tissues with a
characteristic tendency to spread along
perineural lymphatics.

41.  They are usually found in the anterior orbit.
 These may involve orbit, lacrimal glands,
lids and subconjunctival tissue and produce
varied clinical features.
 They are essentially B cell lymphomas and
orbital lymphomas may be the first
manifestation of systemic lymphomas

42.  This is a group of diseases characterised by
an idiopathic abnormal proliferation of
histiocytes with granuloma formation.
 These diseases primarily affect children with
an orbital involvement in 20 % of cases.

43.  These involve the orbit by haematogenous
spread from a distant primary focus and include
the following:
 1. Neuroblastoma — from adrenals and
sympathetic chain.
 2. Nephroblastoma —from kidneys.
 3. Carcinoma — from lungs, breast, prostate,
thyroid and rectum.
 4. Malignant melanoma — from skin.
 5. Ewing’s sarcoma —from the bones.
 6. Leukaemic infiltration.

44.  It is a benign tumour arising from the
astrocytes.
 It usually occurs in first decade of life
 It may be intraorbital or intracranial

45. 1.CAROTID CAVERNOUS FISTULA
2.AV MALFORMATION

46.  It is a common cause of pulsating
exophthalmos.
 This is quite often triggered by head injury,
but may spontaneous due to ruptured
intracavernous aneurysms.
 Symptoms may be characterised by painful
pulsating proptosis with congestion and
edema of conjunctiva and eyelids.

47.  Arteriovenous shunts are rare in the orbit
and mostly occur with whyburn mason
syndrome.
 They present as pulsating exophthalmosis or
subarachnoid haemorrhage.
 These as well as venous angiomas cause
proptosis that is affected by position.

48. GRAVE`S DISEASE
 This term is coined to denote typical ocular
changes which include lid retraction, lid lag,
and proptosis .
 It is the most common causes of proptosis
which mostly affects females.
 Graves’ ophthalmopathy has an autoimmune
etiology.

49.  Mucoceles are para nasal sinuses which
seen more frequently at frontal sinus.
 Which can cause periorbital swelling , pain
and displacement of globe .
 Sphenoidal sinus mucoceles cause
headache, peri or retro-orbital pain and
ophthalmoplegias due to extension into the
orbital apex and cavernous sinus.

50. THANKS...