|Year : 1966 | Volume
| Issue : 2 | Page : 91-93
Haemangioma of the orbit
Government Medical College, Patiala, Punjab, India
|Date of Web Publication||12-Jan-2008|
Government Medical College, Patiala, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh D. Haemangioma of the orbit. Indian J Ophthalmol 1966;14:91-3
In large series of cases of orbital tumour producing exophthalmos such as those of Reese (1941), Forrest (1949) and Drescher and Bendict (1950), haemangioma is the tumour commonly found. Reese found 25 of a series of 109 orbital tumours to be of this type, Forrest 25 of 184, Drescher and Bendicts seventeen in a total of 177. Diagnosis of these tumours has usually rested on clinical features of orbital and ocular disturbances assisted in some cases by the presence of other vascular abnormalities, commonly cutaneous haemangiomata.
The following case is being reported because, the manner in which it presented is of interest and because of the relative infrequency of this tumour as compared to others' series.
The case was unassociated with any visual disturbance. As emphasised by Walsh (1957) and was detailed by Birschherschfield (1930) in the well known series of 92 cases, in 21 all vision had been lost in the affected eye and in 39 a more or less serious defect remained. Exposure keratitis, corneal ulceration from severe proptosis and optic or retinal atrophy from direct pressure or following papilloedema are responsible for visual loss. Unexplained amblyopia appears in an appreciable proportion of cases (Duke Elder, 1952):
In the case presented, there was no visual disturbance nor any change in the fundus, inspite of proptosis and tumour tissue encircling and pressing on the lower inner and outer sides of the optic nerve.
The limitation of movements of eye though slight were early to appear. It is important to note that the mobility of the globe remains unimpaired for a long time (Reese).
In this hospital, 33 cases of proptosis were treated by the department in the last live years, and only two cases lone more in addition to the present case) were found to be of haemangioma orbit (6 per cent) which percentage is much less than the series mentioned already.
| Case Report|| |
Patient Prem Kaur aged 9 years was admitted in November, 1963, with gradually increasing proptosis of the right eye for the last 1½ years, though the parents had noted the prominence of the right eye much earlier. The proptosis was unaccompanied by disturbances of vision, pain, diplopia, headache, vomiting, palpitation, loss of weight. There was no history of sudden increase in proptosis or increase on bending of the head coughing, sneezing or crying.
| Examination|| |
No evidence of cutaneous haemangioma or prominence of blood vessels seen on the face or elsewhere. Pulse and temperature and blood pressure were within normal limits. Thyroid was not enlarged. Neurological and E.N.T. examinations were normal.
| Local Examination|| |
Left eye was normal.
Right eye: There was a forward proptosis of 8 mm. [Figure - 1],[Figure - 2]. The globe was slightly compressible on pressure. The orbital tension was not felt to be very high on digital palpation.
There was no bruit or thrill.
No mass was palpable on trying to pass a finger between the globe and orbital margin.
Movements were slightly limited all around. Lids: There was no evidence of any haemangioma.
The cornea, pupillary reactions, the intra ocular tension, fundus and vision were normal.
| Investigations|| |
Routine blood, urine and stool examinations were normal.
Bone marrow showed an undisturbed M.E. ratio, with normoblastic reaction.
V.D.R.L. and Kahn test were negative. Casoni's test was negative. B.M.R. was normal.
Skiagrams of the skull, sinuses orbit and optic formaina were normal.
| Operation|| |
The orbit was explored through anterior orbitotony under general anaesthesia by external canthotomy and cutting the conjunctiva along upper and lower outer halves of the fornices.
The tumour was seen in the muscle cone with a tendency to protrude through the gap between lateral rectus and inferior rectus.
The tumour was partly encapsulated and contained bluish cysts containing haemorrhagic fluid. The tumour was separated and excised by blunt dissection and its deeper end was seen to extend upto the apex, encircling the outer, lower and inner sides of the optic nerve.
| Histopathology|| |
The tumour was found to be haemangioma.
| Post Operative|| |
The recovery was uneventful. The bandage was removed on the ninth day. The proptosis disappeared and on the 15th day of the operation there was slight enophthalmos of the R.E. and slight limitation of movements upwards and inwards [Figure - 3]. The vision and fundus were normal. Follow up for 9 months showed no change in the pictures.
| Summary|| |
A case of haemangioma of orbit is described, leading to proptosis without any loss of vision. It was operated successfully with uneventful recovery.
| References|| |
Birch Hirschfeld (1930). quoted by H. E. Hobbs, Brit. J. of Ophthal. (1961) 45, 231.
Walsch, F. B. (1957). Clinical Neuroophthalmology, 2nd Ed. 1955, Williams and Wilkins. Baltimore.
Duke-Elder. S. (1952). Text book of Ophthalmology. vol. 5, p. 5666. Kimpton London.
Algernon B. Reese (1953), Tumours of Eye. p. 350, haul, B. Hoeber, Inc.
[Figure - 1], [Figure - 2], [Figure - 3]