Year : 1975 | Volume
: 23 | Issue : 2 | Page : 23--24
Orbital metastasis of mixed parotid tumour
RB Saxena, RN Mathur, SZ Sonani
Department of ophthalmology, Medical College, Jamnagar, India
R B Saxena
Department of ophthalmology, Medical College, Jamnagar
|How to cite this article:|
Saxena R B, Mathur R N, Sonani S Z. Orbital metastasis of mixed parotid tumour.Indian J Ophthalmol 1975;23:23-24
|How to cite this URL:|
Saxena R B, Mathur R N, Sonani S Z. Orbital metastasis of mixed parotid tumour. Indian J Ophthalmol [serial online] 1975 [cited 2020 May 28 ];23:23-24
Available from: http://www.ijo.in/text.asp?1975/23/2/23/31324
Metastatic carcinomas in the orbit have been reported rarely. The most frequent primary site is the breast; other ones are the uterus, cervix, kidney, thyroid, prostate, pancreas and lungs.  Metastasis from parotid gland is an exterme rarity and hence this report of secondaries from a mixed parotid tumour in the orbit.
N.B.H. 60 yrs. female reported on 1.8.1972 with complaints of gradual painless protrusion of right eye for the last 7 months along with gradual diminution of vision in both eyes more so in the left eye.
Past history: She was operated for a right parotid gland tumour in Jan. 72 in the same hospital. Histology had revealed a mixed parotid tumour showing malignant changes.
Examination: Right eye showed axial proptosis of 25 mm. It was tender and non-reducible. There was no impulse on coughing, no diplopia and orbital margins were normal. Ocular movements were slightly restricted in all directions. Conjunctiva showed chemosis. There were posterior sub-capsular lens opacities. Visual acuity was only 6/60 not improving with glasses. Fundus revealed slightly pale disc. Tension was 12.2.mm of Hg and fields showed peripheral constriction. Left eye showed only a mature cataract.
Investigations : Routine blood, stool, urine, B.M.R. chest and E.S.R. examination were normal. Mantoux and Casoni's test were negative. Skiagram of skull, orbit and optic canal were normal.
Exploration of right orbit by Krhonleins' approach revealed an encapsulated oval mass in the muscle cone going far back. Capsule ruptured during manipulations and granular material came out which was removed. No abnormal bleeding was observed. After 20 days of opertion proptosis improved and exophthalmometry was 15 mm with Vision of 6/60.
Histopathology : Section showed structure of carcinoma of mixed salivary glandular type. The tumour was very vascular, many of the blood vessels were lined by tumour cells and tumour cells were also seen in the lumens [Figure 2]. A blood borne metastasis from mixed parotid tumour was suggested.
Follow up A year later patient again reported with proptosis and severe pain in right eye. There was marked oedema of the lids, chemosis of the conjunctiva and haziness of the cornea. Proptosis had again increased. Eye ball was fixed, pupil was semi dilated, intraocular tension was raised and light perception was absent. Simultaneously a firm and non-tender swelling appeared in the right parotid region.
Exentration of the right orbit was done on Sept. 10th, 1973. Orbit was full with mass which was firm in consistency, granular cauliflower like and had infiltrated the medial and inferior wall of the orbit. It had reached beyond the superior orbital fissure and optic foramen.
Histopathology confirmed the previous report.
Six months after exentration patient was seen again with bony metastasis in the temporal region [Figure 3],
Malignant tumours from breast, lungs, supra-renals, thyroid, kidney, prostate and pancreas occasionally send. deposits in the orbit ,,,,, . Metastasis from the mixed parotid tumour in the orbit is an extermely rare condition. Heymann  presented one similar case. It is usually a hematogenous spread and deposits in the orbit, may be single or multiple and both orbits may be involved.  This leads to proptosis and limitations of ocular movements with diminution of vision or diplopia. Tumour may be removed locally but more often requires exentration. In general the prognosis is not good.
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