Lacrimal gland carcinoma

Presents - 4th to 6th decades

Very poor prognosis

Painful, fast-growing mass in

lacrimal fossa
Infero-nasal globe displacement

Posterior extension may cause proptos

ophthalmoplegia and episcleral conges
Trigeminal hypoaesthesia in 25%

Management

Biopsy
Radical surgery and radiotherapy

Lacrimal gland carcinoma

Presents - 4th to 6th decades
Very poor prognosis

Painful, fast-growing mass in

lacrimal fossa
Infero-nasal globe displacement

Posterior extension may cause proptos

ophthalmoplegia and episcleral conges
Trigeminal hypoaesthesia in 25%

Management

Biopsy
Radical surgery and radiotherapy

Optic nerve sheath meningioma

Typically affects middle-aged women

Gradual visual loss due to optic nerve

Optociliary shunts in
compression
30%

Thickening and
Proptosis due to intraconal spread

calcification on CT

Treatment
Observation - slow-growing tumours
Excision - aggressive tumours and poor vision
Radiotherapy - slow-growing tumours and good vision

Lymphoma
Presents - 6th to 8th decades

Affects any part of orbit andAnterior lesions are rubbery

May be confined to
may be bilateral
on palpitation
lacrimal glands
Treatment

Radiotherapy - localized lesions

Chemotherapy - disseminated disease

Rhabdomyosarcoma
Most common primary childhood orbital malignancy
Rapid onset in first decade ( average 7 yrs )

May involve any part of orbit

Palpable mass and ptosis in about 30%

Treatment

Radiotherapy and chemotherapy

Exenteration for radio-resistant or recurrent tumours

Adult metastatic tumours

Common primary sites - breast, bronchus, prostate, skin melanom

gastrointestinal tract and kidney
Presentations

Enophthalmos with schirrous

Anterior orbital mass with nontumours
axial globe displacement

Cranial nerve involvement at orbital

Similar to orbital pseudo-tumour
apex and mild proptosis

Childhood metastatic tumours

Neuroblastoma

Presents in early childhood

May be bilateral
Typically involves superior orbit

Chloroma

Presents at about age 7yrs

Rapid onset proptosis - may be bilate
Subsequent systematic dissemination
full-blown leukaemia

Kelopak mata
Jinak

nervus, veruca, xanthelasma,

hemangioma
Ganas basalioma, squamous cell carcinoma,
adeno carcinoma, melanoma maligna

Konjungtiva
Jinak

nervus, papiloma, granuloma, fibroma,

limfoma
Ganas epidermoid ca, melanoma maligna,
limfo sarkoma

Signs of chalazion (meibomian c

Painless, roundish, firm lesion May rupture through conjunctiv

within tarsal plate
and cause granuloma

Acute
hordeola
Internal hordeolum
( acute chalazion )

External hordeolum (stye)

Staph. abscess of meibomian

Staph. abscess of lash follicle an
glands
associated gland of Zeis or Moll
Tender
Tender swelling within tarsal
plate swelling at lid margin
May discharge through skin
May discharge through skin
or conjunctiva

Xanthelasma

Common in elderly or those with

hypercholesterolaemia
Yellowish, subcutaneous plaques
containing cholesterol and lipid
Usually bilateral and located medially

Eyelid cysts
sweat gland
Cyst of Moll Eccrine
hidrocystoma

Translucent
Similar to cyst of Moll
On anterior lid Not confined to lid
margin
margin

Cyst of Zeis

Sebaceous cyst

Cheesy contents
Opaque
On anterior lid Frequently at
inner canthus
margin

Viral wart (squamous cell papillo

Most common benign lid tumour

Raspberry-like surface

Peduncula
ted

Sess
ile

Keratoses
Seborrhoeic

Actinic

Common in elderly
Affects elderly, fair-skinned individ
Discrete, greasy, brown lesion
Most common pre-malignant skin le
Friable verrucous surface Rare on eyelids
Flat stuck-on appearance
Flat, scaly, hyperkeratotic lesion

Naevi

Appearance and classification determined by location w

Tend to become more pigmented at puberty
Intradermal

Junctional

Elevated

Compound

Flat, well-circumscribed
Has both intradermal
and junctional
May be non-pigmented
Pigmented
components
Low malignant potential
No malignant potential

Capillary haemangioma

Rare tumour which presents soon after

May birth
be associated with intrao
extension
Starts as small, red lesion, most frequently
Grows quickly during first yea
on upper lid

Begins
to involute spontaneou
Blanches with pressure and swellson
crying
during second year

Pyogenic granuloma Cutaneous horn

Usually antedated by surgery or trauma

Uncommon, horn-like lesion pro
through
skin
Fast-growing pinkish, pedunculated
or
sessile mass
May be associated with underlyin
keratosis or squamous cell carcin
Bleeds easily

Frequency of location of basal cell ca

Lower lid - 70%

Medial canthus - 15%

Upper lid - 10%

Lateral canthus - 5%

Squamous cell carcinoma

Less common but more aggressive than BCC

May arise de novo or from actinic keratosis

Predilection for lower lid

Nodul
ar

Hard, hyperkeratotic
May develop crusting
nodule
fissures
No surface
vascularization

Ulcerative

Red base
Borders sharply defined, indurate
and elevated

Melanoma
Nodular

Superficial spreading

From lentigo maligna

(Hutchinson freckle)

Plaque with irregular

Affects elderly
Blue-black nodule with
outline
normal surrounding skin
Slowly expanding
May be non-pigmented
Variable pigmentation
pigmented macule

Kaposi sarcoma

Vascular tumour occurring in patients with AIDS

Usually associated with advanced disease

Very sensitive to radiotherapy

Early

Pink, red-violet lesion

Advanced

May ulcerate and bleed

Naevus

Presents in first two decades Most frequently juxtalimbal

Sharply demarcated and slightly
30% are almost non-pigmented
elevated

Papilloma
Pedunculated

Sessile

Presents in middle age

Presents in childhood or early adulthood
Infection with papilloma virus Not caused by infection
Single and unilateral
May be multiple and bilateral

Epibulbar dermoid
Signs

Presents in childhood
Smooth, soft mass
Usually juxtalimbal

Association

Occasionally Goldenhar
syndrome

Lipodermoid

Presents in adulthood
Soft, movable, subconjunctival mass

Most frequently at outer canthus

Intraepithelial neoplasia
(carcinoma in situ)

Signs

Progression

May become vascular and extend o

cornea
Malignant transformation is uncom
Juxtalimbal fleshy avascular mass
Presents in late adulthood

Conjunctival melanoma
From naevus

From PAM with atypia

Most common type

Very rare

Primary

Solitary nodule
Frequently juxtalim
Sudden increase in size
Sudden appearance of
nodules in PAM
but may be anywher
or pigmentation

Squamous cell carcinoma

Signs

Arises from intraepithelial

neoplasia or de novo
Presents in late adulthood
Frequently juxtalimbal

Progression

Slow-growing
May spread extensively
Rarely metastasizes

Lymphoma

Usually presents in adulthood

Benign or malignant
Salmon-coloured, subconjunctival infiltrate

Retinoblastoma
adalah tumor ganas dalam bola mata yang
berasal dari jaringan embrional retina

Patologi anatomi
sel bulat dengan sedikit sitoplasma serta
nukleus yang berisi banyak kromatin,
berbentuk roset atau pseudo roset

Presentations of retinoblastoma

Leukocoria - 60% Strabismus - 20%

Secondary glaucoma

Anterior segment invasion

Orbital invasion
Orbital inflammation

Early
endophyliticretinoblast
oma

White flat lesion

Placoid lesion

More advanced endophytic

retinoblastoma

Friable white mass

Cottage cheese appearance

Fine surface blood vesselsVitreous seedings

Exophytic retinoblastoma

May be difficult to
Multiglobulated white mass with
overlying retinal detachment visualize
through deep
detachment

CT diagnosis of retinoblastoma
Calcification

Optic nerve involvement

Orbital and CNS extension
Pinealoblastoma

Differential diagnosis of leukoco

Congenital cataract Persistent hyperplastic

Inflammatory cycl
primary vitreous
membrane

Unilateral or bilateral

Coats disease

Unilateral

Unilateral

Unilateral or bilate

Posterior pole toxocara

Advanced retinopa
granuloma
of prematurity

Unilateral

Always bilateral but

may be asymmetrica

Metastase
1.
2.
3.

Kelenjar perihiler dan kelenjar getah

bening yang berdekatan
Lamina kribrosa ke saraf optik
intrakranial
Koroid dan secara hematogen
menyebar ke seluruh tubuh

Pemeriksaan penunjang
X foto

kalsifikasi
USG / CT Scan media keruh

DD :
Katarak
2. Persistent hyperplastic primary vitreus
3. Retrolental fibroplasia
4. Ablasio retina
5. Uveitis
6. Panoftalmitis
7. Perdarahan vitreus
8. Hyaloid kista
1.

1.

Intraokuler dan unilateral

2.

Menyebar ke orbita dan saraf optik

3.

Photocoagulasi (diatermi atau cryoterapi)

enukleasi
Eksenterasi orbita
Radiasi
kemoterapi

Itraokuler & bilateral

Satu mata dienukleasi untuk menentukan

diagnosa sedangkan mata yang lain
konserfatif sambil menunggu hasil PA

1.

Baik stadium dini (stadium

intraokuler)

2.

Buruk tumor bilateral, telah

menyebar ke saraf optik dan
metastase (stadium
ekstraokuler)

Iris melanoma

Usually pigmented nodule

at
Occasionally
non-pigmented
least 3 mm in diameter
Surface vascularization
Invariably in inferior half of iris

Angle involvement may cause

Pupillary distortion, ectropion
glaucoma
uveae and cataract

Iris naevus
Typical

Diffuse

Pigmented, flat or slightly elevated Obscures iris crypts

Diameter usually less than 3 mm
May cause ipsilateral hyperchromi
heterochromia
Occasionally mild distortion of pupil and
ectropion uvea
May be associated with Cogan-Ree
syndrome

Choroidal melanoma (1)

Occasionally amelanotic
Brown, elevated, subretinal mass
Double circulation

Secondary retinal detachment Choroidal folds