Ocular Tumors
Tumors may arise form extraocular structures such as the
lacrimal gland, or from intraocular structures such as the choroid and
the retina.
Benign intraocular tumors are very rare; the more common
malignant tumors may arise from the choroid (malignant melanoma)
and the retina (retinoblastoma).
Tumors of the eye and orbit are classified as following:
Eyelid tumours:
BENIGN EPIDERMAL TUMOURS:
e.g Squamous cell papilloma
BENIGN PIGMENTED LESIONS:
e.g Freckle
MALIGNANT TUMOURS:
e.g Basal cell carcinoma
BCC is the most common human malignancy and typically affects
older age groups. The most important risk factors are fair skin, and
chronic exposure to sunlight.
Ninety per cent of cases occur in the head and neck and about 10% of
these involve the eyelid.
BCC is by far the most common malignant eyelid tumour, accounting
for 90% of all cases.
It most frequently arises from the lower eyelid, followed in relative
frequency by the medial canthus, upper eyelid and lateral canthus.
The tumour is slowly growing and locally invasive but non-
metastasizing.
Squamous cell carcinoma:
SCC is a much less common, but typically more aggressive tumour
than BCC with metastasis to regional lymph nodes in about 20% of
cases. Careful surveillance of regional lymph nodes is therefore an
important aspect of initial management.
The tumour may also exhibit perineural spread to the intracranial
cavity via the orbit. SCC accounts for 5–10% of eyelid malignancies.
Conjunctival tumours:
BENIGN TUMOURS:
e.g conjunctival papilloma
Malignant tumours:
e.g conjunctival sequamous cell carcinoma
IRIS TUMOURS:
Benign tumours e.g iris naevus
Malignant tumours e.g iris melanoma
CILIARY BODY TUMOURS:
Ciliary body melanoma
TUMOURS OF THE CHOROID:
Benign tumours
e.g
Choroidal naevus
Malignant tumours
e.g
Choroidal melanoma
Choroidal melanoma is the most common primary intraocular
malignancy in adults and accounts for 80% of all uveal melanomas .
Presentation peaks at around the age of 60 years.
Diagnosis
• Symptoms are often absent, with a tumour detected by chance on
routine fundus examination.
• Signs
○ A solitary elevated subretinal grey-brown or rarely amelanotic
dome-shaped mass; diffuse infiltration is uncommon.
○ About 60% are located within 3 mm of the optic disc or fovea.
○ Clumps of overlying orange pigment are common
Treatment:
1. Observation:
if it is not possible to determine clinically weather tumour is a
small melanoma or large naevus.
If the tumour is slow growing and present in only seeing eye.
2. Radiotherapy
3.Enucleation
NEURAL RETINAL TUMOURS:
Retinoblastoma
is the most common primary intraocular malignancy of childhood and
accounts for about 3% of all childhood cancers.
Clinical features:
• Presentation is within the first year of life in bilateral cases and
around 2 years of age if the tumour is unilateral. Careful enquiry
about a family history of ocular tumours is critical.
○ Leukocoria (white pupillary reflex) is the commonest presentation
(60%) and may first be noticed in family photographs .
○ Strabismus is the second most common (20%); fundus examination
is therefore mandatory in all cases of childhood squint.
○ Painful red eye with secondary glaucoma, which may occasionally
be associated with buphthalmos .
○ Poor vision.
○ Inflammation or pseudoinflammation .
○ Routine examination of a patient known to be at risk.
○ Orbital inflammation mimicking orbital or preseptal cellulitis may
occur with necrotic tumours .
○ Orbital invasion or visible extraocular growth may occur in
neglected cases
Investigation
• Red reflex testing with a direct ophthalmoscope is a simple
screening test for leukocoria that is easily employed in the
community.
• Examination under anaesthesia includes the following:
○ General examination for congenital abnormalities of the face and
hands.
○ Tonometry.
○ Measurement of the corneal diameter.
○ Anterior chamber examination with a hand-held slit lamp.
○ Ophthalmoscopy, documenting all findings with colour drawings or
photography.
○ Cycloplegic refraction.
• US is used mainly to assess tumour size. It also detects calcification
• CT also detects calcification
• MRI does not detect calcification but is useful for optic nerve
evaluation, detection of extraocular extension
• Systemic assessment
• Genetic studies
Treatment:
• Chemotherapy
• Radiotherapy
• Enucleation
Differential diagnosis:
Persistent anterior fetal vasculature (persistent
hyperplastic primary vitreous)
Retinopathy of prematurity,
Congenital cataract.
Coats disease
Vitreoretinal dysplasia.
NEURAL TUMOURS:
Optic nerve glioma
Optic nerve glioma is a slowly growing,
pilocytic astrocytoma that typically affects children (median
age 6.5 years)
Optic nerve sheath meningioma Optic nerve sheath
meningioma is a benign tumour arising from meningothelial
cells of the arachnoid villi surrounding the intraorbital, or less
commonly the intracanalicular, portion of the optic nerve.
URAL TUMOURS EURA
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PIDERMAL TUMOURS