Malignant Tumours of the Orbit

Sarcoma is mostly round cell. It grows quickly and it is accom­panied by pains. The prognosis is serious not only for vision but also for the patient's life. The treatment is a surgical removal of the whole orbital content (exenteratio orbitae). After the opera­tion X-ray therapy to prevent the development of recurrences and chemical therapy are administered.

Carcinoma. The original orbital tumours are quite rare. Usual­ly they pass into the orbit from the eyelids, cartilage, and cornea. Metastatic carcinoma of the orbit is mostly observed when there is cancer of the mammary gland or uterus. The treatment is surgi­cal, X-ray and chemical therapy are necessary.

Orbital Manifestations of General Diseases

The orbital manifestations of general diseases are various and are mostly caused by neuroendocrine-humoral dysfunctions in the organism, vessel dysfunctions, pathology of the blood system, etc. The leading sign of the orbital manifestations of general diseases is exophthalmos. Sometimes enophthalmia is observed.

Exophthalmos. A differentiated diagnosis is necessary between exophthalmos in phlegmon, tenonitis and tumours of the orbit. A quiet condition of the eyes and absence of pains are characteristic of exophthalmos which develops when there are dysfunctions of the lipoid and calcium metabolism. X-ray and vasography, and also laboratory examinations allow to specify the origin of exophthal­mos and therefore to reveal the possibilities of its treatment and prognosis.

A reductability (the eye comes into the orbit under the pressure, it reponates), a retraction of the upper eyelid and the extension of the eye-slit (a frightened look, the Dalrimple's symptom), incon­sistency between the motions of the upper eyelid and eyeball in the gaze downwards (a lagging behind the eyelid — the Schtel-vag's symptom), insufficiency of the convergence (the Mebius' symptom) are characteristic of exophthalmos when there is diffuse toxic goiter, and sometimes slight fatiguability of the eyes and lac-rimation.

Malignant exophthalmos. Lately, besides exophthalmos of the Basedow's disease there has been distinguished a special disease called malignant exophthalmos as an independent nosological unit.

The most severe form is progressive malignant exophthalmos. The disease affects mostly the middle-aged people (40-60 years old). Exophthalmos may be unilateral or bilateral. Bilateral exophthal­mos develops rarely, as a rule. The disease is progressive. Sometimes eye-bulging reaches such a stage that arbitrary eyeball dislocation occurs. The pains in the orbital area are sometimes so severe that the patient hardly endures. Diplopia and limitation of the eye mo­tion mostly upwards and outwards are characteristic. Development of the intercurrent conjunctivitis and especially keratitis with a ten­dency to ulceration and destruction of the orbit which is caused not only by lagophthalmia but also by the development of the trophic dysfunctions are characteristic of malignant exophthalmos.

The most characteristic symptom of malignant exophthalmos is oedema of the orbital and periorbital tissues. In the increase of the intraorbital tension the optic nerve changes occur: at first an oede-matous disc and then nerve atrophy develop.

By the opinion of the majority of our country and foreign oph­thalmologists pathogenesis of progressive malignant exophthalmos is associated with an abundant production of the thyroid-stimulat­ing hormone by the anterior hypophysic lobe. Malignant exoph­thalmos can appear after the operation for thyroidectomy. It hap­pens because the thyroid hormone — thyroxine hampers the ac­tion of the thyroid — stimulating hormone of the anterior hypo-physic lobe in the normal conditions.

Treatment of malignant exophthalmos consists of the adminis­tration of the symptomatic and hormonal preparations. In severe cases X-ray therapy of the orbital and hypophysic area is used. Sometimes surgical treatment (decompressive orbital trepanation) is also used.

Pulsating exophthalmos. The disease appears during the rupture of the interior carotid artery in the cavernous sinus. As a result of it blood comes into the sinus and then into the superior orbital vein. In each pulsating wave the eyeball pulsates too; that leads to mi­xing of venous and arterial blood.

The ruptures of the internal carotid artery occur in the fractures of the cranial basis, rarely as a result of other injuries of the ves­sel wall. Sometimes pulsating exophthalmos results from trauma­tic aneurysm of the ophthalmic vessels. The disease begins suddenly with a severe headache and severe tinnitus. The eye-ball bulges and pulsates; pulsation is visible and it is felt on palpation. A systolic murmur is heard, especially over the eye on auscultation. This mur­mur is very troublesome for the patient. A pulsate tumour is formed often from above and inside the eye. The oedematous phenomena are observed rarely in the veins of the conjunctiva, sclera, iris, in­traocular pressure increases, a picture of oedematous optic disc; paralyses of the ophthalmic muscles develop in severe cases.

Treatment is surgical, i.e. ligation of the general carotid artery on the neck. S. S. Golovin proposed a ligation and arterioversion of the superior orbital vein.

Date: 2014-12-21; view: 1092