What is an orbital tumor?
An orbital tumor is any abnormal growth or mass that develops within the orbit, the bony cavity in the skull that houses the eye and the structures surrounding it, including the eye muscles, fatty tissue, blood vessels, and nerves. Because the orbit is a compact space, even a small tumor can put pressure on the eye and surrounding structures, causing noticeable symptoms.
Orbital tumors can be benign, meaning non-cancerous, or malignant, meaning cancerous. Some originate directly within the orbit, while others spread to the orbit from a nearby structure such as the sinuses, or from a cancer elsewhere in the body such as the breast, lung, or prostate. Most orbital tumors in both children and adults are benign, though all orbital tumors require evaluation to determine the appropriate course of management.
Types of orbital tumors
Orbital tumors are broadly classified by whether they are benign or malignant, and by the type of tissue from which they originate. Common types include:
Benign Orbital Tumors
- Cavernous venous malformation (also called cavernous hemangioma), one of the most common benign orbital tumors in adults, which develops from abnormal blood vessels within the orbit
- Dermoid cyst, a cyst present from birth that typically appears near the outer edge of the eyebrow and grows slowly over time
- Optic nerve meningioma, a slow-growing tumor that arises from the tissue surrounding the optic nerve
- Optic nerve glioma, a tumor that develops within the optic nerve itself and occurs most often in children, sometimes in association with a condition called neurofibromatosis
- Lymphangioma, an abnormal collection of lymphatic vessels that most commonly affects children and can expand suddenly with illness
Malignant Orbital Tumors
- Lymphoma, the most common malignant orbital tumor in adults, which develops from immune cells within the orbital tissue
- Rhabdomyosarcoma, a rapidly growing malignant tumor that is the most common primary orbital cancer in children
- Metastatic tumors, which spread to the orbit from a cancer originating elsewhere in the body
Tumors that extend into the orbit from adjacent structures such as the eyelids, sinuses, or nasal cavity
What are the symptoms of an orbital tumor?
Because the orbit is a tightly enclosed space, a growing tumor can push the eye out of its normal position and compress the surrounding structures. Common symptoms include:
- A bulging or forward displacement of the eye, known as proptosis
- Double vision or changes in eye movement
- Decreased or blurred vision
- Swelling or a visible mass near the eye or eyelid
- Drooping of the upper eyelid
- Redness or irritation around the eye
- A feeling of pressure or pain around the eye
- Changes in the position of the eye within the socket
Some orbital tumors grow slowly and cause only gradual, subtle changes. Others grow more quickly and produce symptoms that develop over weeks. Any new or unexplained change in the appearance or function of the eye warrants evaluation.
What causes an orbital tumor?
Orbital tumors can arise from any of the tissues within the orbit. Depending on the type, a tumor may develop from:
- Blood vessels within the orbit
- The fatty tissue surrounding the eye
- The muscles that control eye movement
- The nerves supplying the eye, including the optic nerve
- The bony walls of the orbit
- Lymphatic tissue within the orbit
- Congenital abnormalities present from birth
- Cancer that has spread from another part of the body
How is an orbital tumor diagnosed?
Diagnosis begins with a thorough clinical evaluation by an oculofacial plastic surgeon. During this appointment, your surgeon will:
- Review your symptoms, their duration, and any relevant medical history, including any prior cancer diagnosis
- Examine the eye, eyelids, and orbit for changes in position, movement, and appearance
- Assess vision and eye function
Imaging studies are a key part of diagnosing an orbital tumor. This may include a CT scan, which provides detailed images of the bony structures of the orbit and helps determine the size and location of the tumor. An MRI scan may also be used to provide clear images of the soft tissue structures within the orbit and is particularly useful for evaluating tumors involving the optic nerve or surrounding muscles.
In some cases, a biopsy is needed to confirm the diagnosis. A biopsy involves removing a small sample of tissue from the tumor so it can be examined under a microscope to determine what type of tumor is present.
How are orbital tumors treated?
Treatment depends on the type of tumor, whether it is benign or malignant, its size and location within the orbit, and whether it is affecting vision or eye function.
For small, slow-growing benign tumors that are not causing symptoms or threatening vision, your provider may recommend monitoring the tumor over time with periodic imaging to assess any change in size or behavior.
When a tumor is causing vision changes, restricting eye movement, pushing the eye out of position, or when the nature of the tumor requires tissue sampling for diagnosis, surgical removal of the tumor is typically recommended. Most benign orbital tumors can be removed completely through surgery. The surgical approach varies depending on where the tumor is located within the orbit. In complex cases involving the skull base or adjacent structures, your oculofacial plastic surgeon may coordinate with neurosurgery or ear, nose, and throat (ENT) specialists.
Radiation therapy may be recommended for certain tumor types, particularly lymphoma, or when a tumor cannot be fully removed surgically.
Chemotherapy may be used for malignant orbital tumors, including lymphoma and rhabdomyosarcoma, often in coordination with an oncology team.
The oculofacial plastic surgeons at The Iowa Clinic evaluate and treat a full range of orbital conditions, coordinating with other specialists when needed to develop a treatment plan tailored to each patient. Call 515.875.9480 to schedule an appointment.