|Year : 1978 | Volume
| Issue : 2 | Page : 29-31
Glioma of optic nerve
OP Kulshrestha, HN Chhabra, PK Mathur
Department of Ophthalmology, S.M.S. Medical College, Jaipur, India
O P Kulshrestha
Department of Ophthalmology, S.M.S. Medical College, Jaipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kulshrestha O P, Chhabra H N, Mathur P K. Glioma of optic nerve. Indian J Ophthalmol 1978;26:29-31
Glioma is a common primary neoplasm of the optic nerve. Two third of the reported tumours of the optic nerve are gliomas Eighty percent cases are seen in the first decade of life[6}. It is thought to be a congenital tumour, the common mode of presentation is by progressive diminution of vision with fundus picture of optic atrophy followed by axial proptosis.
A case of glioma arising from optic nerve which had many unusual and interesting features is presented here.
| Case Report|| |
A boy aged 12 years, was admitted in eye ward of S.M.S. Hospital, Jaipur in July, 1974 with complaints of progressive and painless proptosis o` right eye of three month's duration. There was no history of trauma or any relevant general ailment.
The right eye was found proptosed and displaced axially forward. The cornea, iris, lens etc. showed no abnormalities. Fundus examination showed early papilloedema of about 3 D on right side. Visual acuity in right eye was 6/24 and J.3. Perimetry showed some peripheral constriction of fields by 13 to 15 degrees. Exophthalmometry showed proptosis of 5 mm. [Figure - 1].
Left eye was normal in all respects including fundus. Vision was 6/6 and J.1. Perimetry was normal. Skiagram of paranasal sinuses, skull and optic foramen were taken. Right foramen was slightly enlarged as compared to the left rest were normal [Figure - 2]. Screening chest, and Haematological examination were normal.
A provisional diagnosis of local tumour in the orbit was made and the case prepared for lateral orbitotomy.
Lateral orbitotomy was done by Kronlein's method. A moderately large firm mass with regular surface was felt in the apex of the orbit, The tumour had completely encircled the optic nerve. It could not be shelled out by any amount of manipulation with index finger and therefore, had to be cut along with the affected part of tte optic nerve at the level of the apex of orbit
On gross examination a pale white tumour was seen firm in consistency, 2.5 cm x 1.5 cm in size arising from the optic nerve and completely encircling it [Figure - 3].
Histopathological examination (under low power, [Figure - 4]) showed proliferation of glial cells with in nerve bundle and cells were disarranged. Glial fibres were not prominent.
Examination under high power [Figure - 5] showed disarranged glial cells with small nuclei. There was absence of pleomorphism and cytoplasm was vacuolated. Myxomatous areas were present (lower right & middle). Nerve fibres were absent.
Postoperatively patient had uneventful recovery with regression of proptosis. However, as expected the entire retina showed picture of obstruction of central retinal artery with generalised pallor and cloudy appearance. The large size arteries were attenuated and the smaller ones were almost invisible. There was marked limitation of abduction on right side. Patient came for followup after six months in February, 1975, which did taut reveal any recurrence of the orbital tumour. There was a marked recovery of abduction but the child developed neuro-paralytic corneal ulcer with hypopyon which healed with a dense leucomatous opacity. However, as there remained a good deal of corneal anaesthesia, tarsorrhaphy was done during the treatment of ulcer to prevent its recurrence and there has been no recurrence so far.
| Discussion|| |
The age of onset and progress of glioma of optic nerve is quite usual in this case but the proptosis preceded the visual loss so much so that the child was not even aware of any diminution the vision. It may have been due to good vision in the second eye or this fact was over looked due to anxiety about proptosis. In advanced cases frequently the eye is displaced down and medially but in this patient there was only axial proptosis. Presentation of papilloedema instead of primary optic atrophy is rather unusual. Reese mentioned the unusual accompaniment of blurring of the disc due to the oedema with normal vision in some cases of glioma. It can possibly be due to relative anterior situation of the tumour initially so as to obstruct the out-going central vein giving rise to a clinical picture of mild papilloedema even before the atrophic process starts in the nerve bundles as a result of pressure. In some of these cases, where the disc appears elevated it is due to actual extension of the tumour itself and some times it is an early manifestation.
The tumour was unilateral which is the usual mode of origin. The other eye may rarely get involved by a spread via chiasma or by multiple origin. In this case the enlargement of optic foramen of the affected right side showed extension of the tumour towards the optic canal but the other eye was not affected. The tumour required lot of digital manipulations in removal that there was damage to the ciliary nerves leading to anaesthesia of the cornea.
Inspite of the fact that the optic foramen was found enlarged, simple excision of the tumour by lateral orbitotomy was considered sufficient. Gliomas are characterised by very infrequent recurrences, an extremely slow growth and have a good prognosis if along with the tumour the involved part of optic nerve is also cut. Duke Elder and Hoyt and Baghdassarian in a series of long follow up ranging from 3 to 41 years concluded that tumours which extended intracranially even tend to remain static. Seal and Das Gupta also observed that even in cases with moderate enlargement of the optic foramen, local excision is not followed by a recurrence or an intracranial extension. Considering the benign course taken by these tumours simple excision through lateral orbitotomy was quite justified.
| Summary|| |
A case of glioma of the optic nerve in a child with some unusual mode of presentation and complete excision of the tumour by lateral orbitotomy is reported.
| References|| |
Davis, F.A., 1940, Arch. Ophthal., 23, 735, 967.
Duke Elder, 1971, Systems of Ophthalmology, 12, 236. Neuro Ophthalmology,
Henry Kimpton, London.
Hoyt, W.E. and Baghdassarian, S.A. 1969, Brit. Jour. and Ophth., 53, 793.
Reese, A.B., 1963 Tumours of eye, 162, Hoeber
Medical Division, New York.
Seal, G.N. and
Das Gupta, 1974, Indian. Jour. Ophthal., 43, 22.
Verhoeff, 1932, Trans. Amer. Ophth, Soc., 30,
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]