Eyelid and Orbital Tumors

A tumor can be either benign or malignant. Benign tumors often remain localized, while malignant tumors often spread into surrounding structures. A tumor can affect the eye socket, eyeball, eye muscles, optic nerve, fat, and tissues.

Eyelid Tumors

Basal cell carcinomas are the most frequently encountered kind of cancer affecting the eyelid, making up 85% to 95% of all malignant eyelid tumors.

The most common location is the inner portion of the lower eyelid, particularly in elderly, fair-skinned people.

There are many different types of basal cell carcinomas, but the nodular variety is one of the most common. It appears as a raised, firm, pearly bump with tiny blood vessels. If the bump is in the eyelash area, some lashes may be missing. The bump may have some surface missing or crusted over and look like an eyelid stye. Although these tumors are malignant, they rarely spread elsewhere in the body.

Squamous cell carcinoma is the second most common kind of cancerous eyelid tumor (occurring in approximately 5% of malignant eyelid tumors).

As with basal cell carcinoma, the most common location is the lower eyelid, particularly in elderly, fair-skinned people.

This tumor also appears as a raised bump that can lead to loss of eyelashes in the involved area. When detected and treated early, the outcome for these tumors is excellent. However, if the tumor is neglected, it can spread to the lymph nodes in the neck.

Sebaceous cell carcinoma originates in glands of the eyelid in elderly individuals. It is relatively rare but still accounts for 1% to 5% of cancerous eyelid tumors. These are highly malignant tumors that may come back after removal, invade the eye socket, or spread to lymph nodes. The tumor may look like an eyelid stye, making it difficult to diagnose.

Malignant melanoma makes up almost 1% of all cancerous eyelid tumors but accounts for many of the deaths from malignant eyelid tumors. Any areas of unusual or changing pigment on the skin should be examined, especially if it is growing or changing color.

Orbital Tumors

The orbit is the bony socket that contains the eye, the muscles that move the eye, the optic nerve, and all the related nerves and blood vessels.

Signs of an orbital tumor include:

  • Bulging of the eyeball

  • Visual loss

  • Double vision

  • Pain

The different kinds of orbital tumors include:

Optic nerve glioma, a benign tumor often associated with neurofibromatosis

Orbital meningioma, a tumor growing from the tissue covering the brain

Hemangioma, a benign tumor made up of blood vessels or vessel elements

Lymphangioma, a tumor made up of enlarged lymphatic vessels

Neurofibroma, a tumor made up nerve cells

Sarcoma, a malignant tumor growing from connective tissue

Metastasis, a malignant tumor that spreads to the orbit from other parts of the body.

Treatment

For most eyelid and orbital tumors, surgical removal is an effective treatment. In severe cases when an eyelid tumor has been neglected for a long time, it can spread into the eye socket. This may ultimately require removal of the eye and adjacent tissue. Some orbital tumors may require different or additional treatments. For malignant tumors including sarcomas and metastases, radiation therapy and sometimes chemotherapy are necessary.

Tests/Diagnosis

Once a tumor is discovered and imaged with magnetic resonance imaging (MRI) or computerized tomography (CT scan), it is usually necessary to perform a biopsy or remove the tumor in order to diagnose it and determine whether it is benign or malignant.

Causes/Risk Factors

Prolonged exposure to sunlight seems to be a risk factor for developing basal cell carcinoma. Malignant melanoma on the eyelid can arise from a pre-existing nevus or mole or may arise with no other pre-existing cause. Again, these tumors tend to occur in sun-exposed areas of elderly, fair-skinned people. Sometimes tumors grow into the eye area, or tumors from other parts of the body travel to the eye. Most tumors of the eye are benign.