Year : 1979 | Volume
: 27 | Issue : 4 | Page : 224--225
Expanding orbital lesions in children
PK Agrawal, Dipak Kumar, CL Rangwala
K.G. Med. College, Lucknow, India
P K Agrawal
K.G. Med. College, Lucknow
|How to cite this article:|
Agrawal P K, Kumar D, Rangwala C L. Expanding orbital lesions in children.Indian J Ophthalmol 1979;27:224-225
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Agrawal P K, Kumar D, Rangwala C L. Expanding orbital lesions in children. Indian J Ophthalmol [serial online] 1979 [cited 2021 Jan 22 ];27:224-225
Available from: https://www.ijo.in/text.asp?1979/27/4/224/32641
Orbital lesions in the paediatric group differ from those in adults as regards both the nature of the lesion as well as its clinical manifestations. Children are more susceptible to geographical, environmental, genetic, developmental and socio-economic factors. Innumerable reports on orbital lesions in general are available but a comprehensive work specifically on children, is lacking. We have in this study made an endeavour to bring out this important ophthalmological aspect of childhood disease.
We are presenting a series of 100 cases which came under our care over a period of five years.
The cases are grouped under three broad aetiological headings: Inflammatory, Neoplastic and parasitic (see [Table 1] below)
Age and Sex distribution
Of the 100 cases 66 were male and 34 female indicating a significantly higher male incidence.
The cases divided into three groups.
Groups I: 0-5 years, Group 11 6-10 years, Group III 11-14 years. These groups respectively consissted of 60,
30 and 10 cases. This reveals that incidence of expanding orbital lesions, is commonest in the younger ages,
being the highest in children between 0-5 years age.
A total of 30 cases fell under this category. Of these 6 cases were of acute inflammation while 24 cases revealed a chronic inflammatory process. All acute cases were recognised as clear-cut orbital celiulitis. Of these one had repeated attacks and progressed to an orbital abcess. Radiological investigation revealed an Ethmoidal mucocele extending into the frontal sinus as well. The sinuses were explored and drained after which the proptosis regressed completely.
Chronic inflammatory lesions (24 cases) formed the bulk of all inflammatory lesions (30). Of these 24 cases; 14 were due to chronic osteomyelitis and 10 cases due to inflammatory pseudotumors. Cases of osteomyelitis were all found to be tubercular in origin and presented with either cold abcesses, sinuses, chronic ulcers or proptosis. In one case the lacrimal gland was also involved alongwith the bone. Most cases improved by a combination of antitubercular therapy with surgical procedures consisting of orbitotomy, scraping and repair or drainage and curetage.
All of the 10 cases of inflammatory pseudo-tumours presented with proptosis. 3 cases were proved to be of tubercular origin, had primary lung complexes and responded after antitubercular therapy. 2 cases regressed on being administered a course of antibiotics in combination with steroids. In 5 cases lateral or anterior orbitotomy with excision had to be resorted to.
It was found to be the largest aetiological group; comprising of 66 cases. For convenience of description, we have divided these into 3 broad groups: primary, local orbital extension and metastatic.
Local orbital extensions comprised the majority of neoplastic involvement of the orbit. 36 cases were observed in this category of which retinoblastoma alone comprised 35 cases. Thus this is easily the most important single cause of pathological expansion of the orbit in children. The oldest patient recorded was a girl of 10 years.
Closely following is the group of primary tumours, which consisted of 27 cases. Haemopoetic tumours e.g. lymphoma, myeloid leukaemia and chloroma, constituted 13 cases. We observed 6 cases of congenital ox developmental tumours like dermoid cysts, congenita: cystic eyeball and teratoma. One case of mesenchymal tumour, 2 cases of cavernous haemangioma were observed. Among nerve tissue tumours we observed 5 cases including glioma 'of optic nerve and neuro fibrioma.
A case of non-chromatin paraganglioma (proved by histopathology) clinically diagnosed as sarcoma, was seen in this group.
The metastatic group comprised of 3 cases, 2 were of secondary of neuroblastoma and 1 on Ewings sarcoma which again is a rare occurence. This was seen in 19 years old boy.
All cases of neoplastic lesions presented with proptosis excepting the 2 cases of cystic eyeball. Diagnosis was either clinically very evident or biopsy proved. Orbital exploration and resection were done whenever thought feasible. Rest were submitted to radiotherapy and a few to chemotherapy. Long term results could not be assessed properly as patients seldom came for follow-ups. Short term results were good in most of the cases.
Parasitic Cysts: 4 cases of proptosis due to parasite were observed. All had hydatid cysts. Of these 2 cases had a positive Casonis test. In all cases, the orbit was explored and the cyst removed with good results.
100 cases of expanding orbital lesion in childhood have been analysed on this study.