Periorbital Mass Research Articles

An approach to pediatric brow dermoids: An upper eyelid crease incision

Dermoids are common periorbital masses in children. Traditional surgical approaches have included direct incision over the mass, above, below or through the brow and parallel to the superior orbital rim, a Lynch incision, a lateral canthotomy or an upper eyelid crease and orbicularis oculi splitting incision. We report a case of a child with a lateral brow dermoid whose lesion was successfully removed via an upper eyelid crease approach that avoided an orbicularis oculi incision.

Ocular Ultrasonography in Horses

Ocular ultrasonography is a practical and valuable examination tool for horse eyes with anterior opacities that preclude ophthalmoscopy of deeper structures. Ultrasonography is indicated in cases of periocular trauma, exophthalmos, corneal masses, corneal edema and/or infiltrates, cataracts, and anterior uveitis. Transducers of 7 to 10 MHz may be used to identify and characterize cataracts, lens luxation, lens rupture, vitreal opacities, retinal detachment, endophthalmitis, microphthalmos, buphthalmos, and periorbital masses. High-resolution ultrasonography, using frequencies of 20 MHz and greater, provides improved detail of anterior segment structures. Ultrasound image artifacts are common, requiring knowledge of ocular anatomy and basic ultrasonographic principles for accurate interpretation.

Periorbital Lymphatic Malformation: Clinical Course and Management in 42 Patients

Lymphatic malformation in the orbital cavity and surrounding region often causes disfigurement and visual problems. To better clarify the evolution and treatment of this condition, the authors studied a retrospective cohort of 42 consecutive patients seen between 1971 and 2003 and analyzed anatomic features, complications, and management. The ratio of female to male patients was 1:1. Most periorbital lymphatic malformations were noted at birth (59 percent), presenting as either unilateral swelling (60 percent) or a periorbital mass (24 percent). Sixty-two percent of lesions were on the left side. The ipsilateral cheek, temple, and forehead also were involved in 57 percent of patients. Twenty-two percent of lesions were intraconal, 30 percent were extraconal, and 48 percent were in both spaces. Forty-five percent of children had an associated cerebral developmental venous anomaly. Periorbital lymphatic malformation caused major morbidity; 52 percent of patients had intralesional bleeding and 26 percent of patients had a history of infection. Other common complications included intermittent swelling (76 percent), blepharoptosis (52 percent), proptosis (45 percent), pain (21 percent), amblyopia (33 percent), chemosis (19 percent), astigmatism (17 percent), and strabismus (7 percent). Ultimately, 40 percent of children had diminished vision and 7 percent became blind in the affected eye. Management of periorbital lymphatic malformation involved an interdisciplinary team that included an interventional radiologist, a craniofacial surgeon, and an ophthalmologist. The two therapeutic strategies were sclerotherapy (40 percent) and resection (57 percent); most patients required several interventions. A coronal approach was used for subtotal excision of fronto-temporal-orbital lymphatic malformation in 13 patients, whereas a tarsal incision was used for lesions isolated to the eyelid (n = 14). Ocular proptosis was temporarily managed by tarsorrhaphy (n = 9), but expansion of the bony orbit was needed to correct persistent proptosis (n = 8). Orbital exenteration was necessary in two patients.

Squamous cell carcinoma associated with a periorbital mass in a veiled chameleon (Chamaeleo calyptratus).

This report describes a squamous cell carcinoma in a 1-year-old female veiled chameleon (Chamaeleo calyptratus). The lesion developed as a small (1 by 1 mm) left periocular discoloration of a scale never involving the eye. The mass was first diagnosed as an abscess, increased in size (4 by 8 by 3 mm), and recurred after two surgical resections combined with antibiotic therapy. Poor nutritional condition and egg production by the chameleon complicated management of this condition. The mass was removed surgically a third time at which point histopathologic evaluation revealed a locally invasive squamous cell carcinoma. Bacterial culture of the mass isolated a pure culture of Pseudomonas aeruginosa. Ceftazidime was administered at 20 mg/kg IM every 48 h for 20 days. The animal died 3 months later from complications during an ovariohysterectomy for pregnancy toxemia and oviduct inertia. Necropsy showed no local recurrence or metastasis of the tumor.

Orbital giant cell fibroblastoma

BACKGROUND This report describes the clinical and morphologic (light and electron microscopic and immunohistochemical) features of orbital giant cell fibroblastoma which, to the best of our knowledge, has not been reported before in the ophthalmological literature. METHODS Clinical symptoms, computed tomography (CT), and magnetic resonance (MR) features, light and electron microscopic and immunohistochemical findings were reviewed in a 65-year-old woman who developed an orbital giant cell fibroblastoma. RESULTS The patient presented with a large, infiltrating, intra- and periorbital mass, causing severe proptosis, ocular displacement, and visual loss on the left side. CT and MR imaging demonstrated a large, irregular tissue density in the orbit leading to displacement of the globe anteriorly and inferolaterally. With T 1 -weighted MR images, the lesion was isointense to the gray matter of the brain and revealed marked enhancement with Gd-DTPA. Histopathologically, the tumor consisted of a mixture of spindle and multinucleated giant cells scattered within a myxomatous stroma. CONCLUSION Giant cell fibroblastoma, a benign mesenchymal tumor of infancy, is rarely encountered within the orbital region. This lesion is considered to be a distinct, non-metastasizing tumor, but its clinical management may be very difficult, as in our case, because of its invasive nature and potential for recurrence.

Hepatocellular carcinoma metastasizing to the orbit diagnosed by fine needle aspiration cytology

Hepatocellular carcinoma (HCC) rarely metastasizes to the orbit. We report a case of a 78-year-old man with a past history of HCC, who presented with a periorbital mass, which was diagnosed as metastatic HCC by fine needle aspiration cytology (FNAC) and subsequently confirmed on excision biopsy. The cytological, histopathological and immunohistochemical findings are presented and the differential diagnosis is discussed. To our knowledge there has been no previously reported case of HCC metastatic to the orbit diagnosed by FNAC.

The “Dural Tail Sign”

Periorbital masses are often referred to oculoplastic surgeons. We report a 20-year-old patient presenting with a tender supertemporal mass that on gadolinium-enhanced magnetic resonance imaging (MRI) demonstrated a prominent dural enhancement adjacent to the mass, the so-called "dural tail sign." This sign has been reported to be highly specific for a meningioma; however recent literature challenges this view. In this case as well, the "dural tail sign" was not produced by a meningioma.

Idiopathic hypertrophic cranial pachymeningitis: a case report

Hypertrophic pachymeningitis is a rare fibrosing inflammatory process involving dura mater and tentorium. In this report we are presenting contrast enhanced MRI findings of an unusual case of pachymeningitis which presented with a periorbital mass due to dural sinuses occlusion and retrograde filling of periorbital veins through superior sagittal sinus.

High resolution ultrasound with Doppler: a diagnostic adjunct in orbital and ocular lesions in children.

Twenty-six infants and children with orbital and ocular pathology were examined with ultrasound (US) utilizing real-time imaging and Duplex Pulsed Doppler evaluation. Twenty-two of these patients underwent concurrent orbital computed tomography (CT) and two had magnetic resonance imaging (MRI). Orbital and periorbital lesions included hemangioma, dermoid, lymphangioma, rhabdomyosarcoma, encephalocoele and abscess. Ocular lesions included infection, trauma, retinal detachment, retinoblastoma, Coat's disease, and persistent hyperplastic primary vitreous. High resolution US with Doppler provided unique diagnostic information in patients with penetrating ocular trauma, orbital and periorbital masses, and intraocular structural abnormalities. High resolution US examination of the eye and periorbital tissues is readily performed using widely available equipment and often delineates subtle structural abnormalities not shown by CT or MRI.

Periorbital Hematoma Secondary to Sinusitis in a Child

Periorbital abscess secondary to sinusitis is a well-recognized entity in children. However, subperiosteal hematoma is extremely rare and has been reported in only four adult patients. This article presents the case of a 4-year-old girl with sinusitis, proptosis, and decreased visual acuity. Surgical exploration of the orbit revealed the presence of a large organizing subperiosteal hematoma that was drained. The presence of a periorbital hematoma should be suspected in patients with acute onset of proptosis and findings of a periorbital mass and sinusitis on computed tomographic scan.

Fine‐needle aspiration biopsy of orbital and periorbital masses

We present the cytologic findings of 18 fine-needle aspirates performed on orbital and periorbital masses. An accurate specific diagnosis was confirmed by histology in ten cases. In eight cases the diagnostic evaluation and/or therapeutic regimen was significantly altered by the results of the fine-needle biopsy. In three cases the cytologic diagnoses obviated the need for open biopsy. Two specimens were insufficient for diagnosis. No false positive diagnosis of malignancy occurred. Electron microscopy was useful in three cases to confirm the correct cytologic diagnosis. Immunocytochemistry helped to define a lymphoid proliferation as monoclonal. The cytologic findings from an unusual case of sebaceous carcinoma are presented.

Osteosarcoma in a Phthisical Feline Eye

Eight years ago a cat sustained injury to the left globe and phthisis bulbi ensued. Two months prior to presentation, a firm intraorbital and periorbital mass developed and enucleation was done; histologic examination revealed osteogenic sarcoma. This is the first histologically documented report of osteosarcoma occurring in association with phthisis bulbi.