Retro-orbital tumour

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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240 Retro-orbital tumour

Instruction

Examine this patient’s eyes.

Salient features

History

• History of atherosclerosis

• History of hypertension

• History of diabetes

• History of trauma to the eye or head.

Examination

• Unilateral exophthalmos (proptosis; Fig. 240.1)

• Impaired extraocular movement (from either muscle or nerve involvement)

• Chemosis, conjunctival oedema

• Radiation marks may be present.

image

Fig. 240.1 Proptosis of the left eye from a retro-orbital tumour.

(With permission from Yanoff, Fine 2002.)

Proceed as follows:

• Examine the visual acuity and visual fields.

• Look for pulsations over the globe.

• Palpate the orbital margin for erosion of the underlying bone.

• Auscultate over the globe for bruit.

Diagnosis

This patient has a retro-orbital tumour with a bruit over the globe (lesion), indicating a pulsatile structure such as an arteriovenous fistula in the orbit (aetiology). The tumour is causing considerable distress to the patient (functional status).

Advanced-level questions

What is your differential diagnosis?

• The commonest cause of unilateral exophthalmos is Graves’ disease.

• Other causes are:

• retro-orbital tumour (primary or metastatic)
• arteriovenous fistula (carotico-cavernous fistula)
• cavernous sinus thrombosis
• orbital cellulitis.

What investigations would you do?

• Throxine, thyroid-stimulating hormone (TSH), free thyroxine

• Orbital ultrasonography

• Cranial MRI, in particular the orbits.

How would you manage such a patient?

• Ophthalmology opinion

• Therapy: radiation to the orbit and steroids, and surgical decompression, depending on the underlying aetiology.

What are the causes of a unilateral pulsating proptosis?

• Arteriovenous fistula between the carotid artery and cavernous sinus: stops with pressure on the artery in the neck

• Aneurysm of the ophthalmic artery

• Cirsoid aneurysm of the orbit

• Vascular neoplasms in the orbit growing rapidly.

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240 Retro-orbital tumour

Instruction

Examine this patient’s eyes.

Salient features

History

• History of atherosclerosis

• History of hypertension

• History of diabetes

• History of trauma to the eye or head.

Examination

• Unilateral exophthalmos (proptosis; Fig. 240.1)

• Impaired extraocular movement (from either muscle or nerve involvement)

• Chemosis, conjunctival oedema

• Radiation marks may be present.

image

Fig. 240.1 Proptosis of the left eye from a retro-orbital tumour.

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