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| ARTICLES |
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| Year : 1976 | Volume
: 24
| Issue : 1 | Page : 36-38 |
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Orbital lymphangioma (regression with corticosteroids)
SP Dhir1, IS Jain1, BN Dutta2
1 Postgraduate Institute of Medical Education & Research, Chandigarh-160011, India
2 Department of Pathology, Postgraduate Institute of Medical Education & Research, Chandigarh-160011, India
Correspondence Address:
S P Dhir
Postgraduate Institute of Medical Education & Research, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1031384 
How to cite this article:
Dhir S P, Jain I S, Dutta B N. Orbital lymphangioma (regression with corticosteroids). Indian J Ophthalmol 1976;24:36-8 |
Orbital lymphangiomas constitute the largest group among the lymphangiomas involving the ocular adnexa. The tumour manifests primarily in young children. The treatment of lymphangiomas has not been very satisfactory. Since these tumours grow slowly, repeated partial excision and plastic repair over a period of years may gradually get ahead of the tumour and lead to a satisfactory result.[3] These tumours are not amenable to radiation treatment[1].
We report a case of orbital lymphangioma who showed marked regression following systemic corticosteroid therapy.
| Case Report | |  |
MR. a 4 year old male was seen in paediatric surgical unit with complaint of swelling of the right eye for the past three months, after trauma. The swelling has been gradually increasing in size. Patient was investigated in surgical unit for nephroblastoma with secondaries in the orbit. On ophthalmic consultation, a diagnosis of haemangioma or lymphangioma was suggested and patient was transferred to ophthalmology service.
On examination visual acuity was found good. The right eyeball was pushed forwards, laterally and downwards [Figure - 1]. The upper lid showed irregular swelling with bluish coloration. On palpation the swelling was irregular, cystic and non-tender. The skin over the swelling was freely mobile. The swelling could not be reduced. No bruit was heard over the swelling. Left eyeball was in its proper position.
Right cornea showed exposure keratitis in the lower one third. Both fundi were normal and no regional or other lymph glands were palpable.
A clinical diagnosis of haemangioma or lymphangioma was made. X-ray examination, haemogram and skin test for hydatid disease were non-contributory. Under general anaesthesia a needle was passed into the cystic medial swelling through the upper eye lid and ½ ml. of straw coloured fluid was obtained. The fluid did not clot. Fluid was examined for any evidence of parasites, but none were seen. Through a conjunctival incision in the upper fornix, a small cystic mass was obtained for histo-pathological examination.
Histo-pathological Examination
The tissue consists of dilated tortuous channels, some of which are of cystic proportions. The channels are made up of a fibro-muscular thin walls lined by endothelium and contain a few lymphocytes, but no red blood cells. The wall is somewhat myxomatous. In between the channels occasional focus of mono-nuclear cell clusters is seen [Figure - 3]. The above features are consistent with the diagnosis of cystic lymphangioma without any significant inflammatory reaction.
After the histo-pathological diagnosis of orbital lymphangioma, the patient was advised orbitotomy and surgical removal of the tumour. However, following the I report of regression of haemangioma of the orbit with corticosteroids in the literature[2],[4], patient was put on corticosteroids, (tab. Prednisolone 20 mg. daily) for one week. The proptosis started regressing by the end of the week and the corticosteroids were continued for another three weeks. By that time proptosis regressed remarkably [Figure - 2]. Corticosteroids were gradually tapered over a period of three weeks and patient was followed for another 4 months.
The child has since maintained regressed proptosis for over nine months.
| Discussion | | |
On histo-pathological review of the mass two points were specifically looked into i.e. the possibility of the lesion being a hemangiolymphangioma or the inflammatory lesion. Haemangioma of the eyelids as well as skin have been reported to regress with systemic steroids. No evidence of haemangioma could be found in this case. The inflammatory reaction was significantly absent which ruled out the possibility of resolution of the lesion due to anti-inflammatory effect of corticosteroids.
It seems that not only haemangiomas of the lid and orbit but lymphangiomas can also regress following systemic administration of corticosteroids and warrant a trial in such cases. The mechanism of action is not yet clearly understood. Neonatal haemangioma of the orbit and ocular adnexa have been successfully controlled with corticosteroid therapy.
| Summary | | |
A histologically proved case of cystic lymphangioma of the orbit is reported. The proptosis regressed remarkably after systemic administration of corticosteroids. No evidence of haemangioma or inflammatory cells was found on histological review of the slide. Patient maintained regressed state of proptosis over nine months.
| References | | |
| 1. | De Voe, A.G. 1966, "Symposium on Surgery of Ocular Adnexa" Published by C.V. Mosby Company Saint Louis, Page 166.  |
| 2. | Hiles, D.A. and Pilchard, W.A. 1971, Amer. J. Ophthalmol, 71, 1003. |
| 3. | Reese, A.B. 1966, "Tumours of the Eye" Published by Harper and Row Publishers, New York, p. 423. |
| 4. | Venecia G. and Lobeck C.C. 1970 Arch. Ophthal 84, 98. |
[Figure - 1], [Figure - 2], [Figure - 3]
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