EYE TUMOR

NAMA : AISYAH
NIM : I1011131042
 Eye tumor or orbital tumor is a tumor that affect orbital space and it may
result to damage in soft tissue around the eye like; eye muscle, nerve and
lacrimal glands
Tumors generally divided into neoplasm and non-neoplastic tumor.
Neoplasma could be malignant or benign. Malignant tumor happens when
cells divide uncontrollably and invade other tissues. Benign tumors grow with
clear margin and doesnt invade other tissue, benign tumors usually will not
metastasize.
 ANATOMI RONGGA ORBITA

The orbit is a four-sided pyramid

which points back into the head
with the optic foramen at its
apex and the base of this
pyramid is aditus orbitae;
The orbit possesses four walls ;
medial wall, lateral wall, orbital
roof, and floor.
 ORBITAL TUMOR CLASSIFICATION
No Origin Type of tunor
1 Lacrimal glands Pleomorfik adenoma
Carsinoma
2 Lymphoid tissue Lymphoma Intraorbital tumors can
3 Retina Retinoblastoma, Melanoma originate from the structure
inside or around orbital
4 Bone Osteoma, Dermoid cyst, Epidermoid cyst
space. There are
5 Optic nerve seath Meningioma intraorbital classification
6 Optic nerve Glioma, Neurofibroma based on tissue :
7 Connective tissue Rhabdomiosarkoma
8 Blood metastasize Adult: Ca mammae, Ca bronchial
Child: Neuroblastoma, Sarkoma Ewing,
Leukemia, Tumor testikuler
 Clinical manifestation
Orbital pain : Ussually in malignant tumors that growing fast
Proptosis : Anterior displacement of the eye from the orbit is ussually seen
gradually grow and painless (benign tumor) or fast (malignant lesion)
Oedema palpebra : might clear on pseudotumor
Palpation: Could show mass that caused eyelid or eyeball distortion,
especially lacrimal glands tumor with mucocele
Eye movement: Ussually limited by mechanical cause
Visual acuity: may be disturbed due to damage of optic nerve or retina or
indirect cause by vascular damage
 Benign eyelid tumor
Melanocytic nevi
Melanocytic nevi are benign neoplasms or hamartomas composed of
melanocytes, the pigment-producing cells that constitutively colonize the
epidermis

Nevi originate from nevi cells which is

incomplete differentiation of melanocyte at
epidermis, dermis, dermis and dermo-
epidermial junction. Nevi ussually found at
palpebral margin, ussually grow at ocular
surface
Melanocytic nevi represent
proliferations of melanocytes that are in
contact with each other, forming small
collections of cells known as nests.
 Clinical manifestation
Junction nevi: Generally hairless, bright to dark-brown maculae, have variation of
size ranging from 1 mm - 1 cm (diameter), soft and flat surface. Active formation of
nevi cells usually occurs at dermo-epidermal junction.
Compound nevi : almost same with junctional nevi, but display elevation relative to
surrounding uninvolved skin and have papilomatus shape. Compound melanocytic
nevi are often lighter in color than junctional nevi and range from tan to light brown.
Nevi cells located at epidermis and dermis.
Intradermal nevi : Dome-shaped, have variation of size ranging from mm to 1 cm or
more in diameter. Nevi cells located in dermis.
 Treatment

Melanocytic nevi can be surgically removed by excision with biopsy

excision technique, shave excision, electrodesiccation and complete
extirpation due to cosmetic consideration or because of indication of
potential biological lesion turn into malignant.
 Hemangioma palpebra
Hemangioma is hemartomatous grow that consist of proliferated capillary
endotel cells. Hemangioma found in beginning phase of active growth in
baby and followed by regression and involution
Prevalence of infantil hemangioma 1-3% in neonatus and 10% at baby
till 1 year age
Infantil hemangioma mostly occur at caucasian than africans or
americans.
 Patophysiology
Till today the pathogenesis of hemangioma is still not understood.
Although growth factors and hormonal and mechanical influences have been
postulated to affect the abnormal proliferation of endothelial cells in
hemangioma
Angiogenic factors might have important role at proliferation phase and
involution of hemangioma. Fast growing endothelial cells in hemangioma.
have similarity with capillary proliferation in tumors,
Endothelial proliferation affected by angiogenic agents. Angiogenic
agents work in two way :
Directly afect endothelial mitosis of vascular.
Indirectly affect macrophag, mast cell, and T helper cell.
 Clinical manifestation
Clinical manifestation of hemangioma different based on the type. Cappillary
hemangioma appear at a few days of birth. Strawberry nevus seen as red mark that
will grow bigger
Purple-red erythematous or nodus. Ussually deflate and look pale when pressed and
when released it will back to purple-red colour.

HEMANGIOMA KARVENOSUM
HEMANGIOMA KAPILER
 TREATMENT
CONSERVATIVE TREATMENT
Normally, hemangioma lesion will grow bigger in the first month and will reach
maximum growth, then there will be a spontaneous regression at about 12 month
ages. The regression of lesion will continue to 5 years of age. Strawberry hemangiomas
ussually doesnt have any therapy. If the hemangioma left alone, the result is a normal
skin appearance
Active treatment
Active treatment apply on hemangioma that grow in vital organ (eye, ear), have
ulceration, bleeding, infectio, fast growing, and tissue deformity.
Compression therapy
Corticosteroid theraphy
Surgical theraphy
Laser theraphy
 Xanthelasma
Xanthelasma defined as cholesterol deposit under the skin with yellow
clear margin ussually at anterior surface of palpebraa so called palpebral
xanthelasma
In study case of patient with xanthomatosis, xanthelasma ussually found in
32% woman and 17,4% man. The age of onset of xanthelasmas ranges from
15-73 years with a peak in 4th-5th decades
 Clinical manifestation
Appear as irregular plaques in skin, yellow colour ussually around the eye.
Xanthelasma size ranging from 2-30 mm, it could be symmetrical and tend to
be permanent. Patient dont complain about itch and ussually complain for
aesthetic cause. Palpebra xanthelasma ussually located at medial side of
upper medial eyelid. Lesion have yellow colour and soft plaques consist of lipid
deposit with clear margin.
 Pathophysiology
A half of xanthelasma patient have lipid disorder. Xanthelasma eruption
could be found in primer and secondary hyperlipidemia. Primer genetical
disorder including dislipoproteinemia, hypertrigliseridemia, and lipoprtotein
lipase deficiency. Uncontrolled diabetic could be cause for secondary
hyperlipidemia.
 Treatment
Surgical Excision
1.For small linear lesions, excision is recommended, as scarring should blend
in with the surrounding eyelid tissue
2.Simple excision of larger lesions risks eyelid retraction, ectropion, or the
need for more complicated reconstructive procedures
3.Carbon dioxide and argon laser abration
4.Enhanced hemostasis, better visualization, lack of suturing, and fast
Chemical cauterization
The use of chlorinated acetic acids has been found to be effective in the
removal of xanthelasma. These agents precipitate and coagulate proteins
and dissolve lipids
 Malignant tumors of Palpebra
Basal cells carninoma of the eyelid
Basal cells carcinoma of the eyelid is the most common carcinoma of the
eyelid (almost 90%)
This type of cancer almost never spread to another body part, but it can
cause tissue damage to disability due to tumor growth into surounding
tissue
Etiology :
1. Ultraviolet radiation from sun (UVB)
2. Exposure to arsen through digestive track, especially at medication of
asthma and psoriasis
3. Patient who have decreasing immune system (imunosupression), for
example; recipient of organt transplantation, AIDS patient
4. Xeroderma pigmentosum is a genetic disorder of DNA repair in which the
ability to repair damage caused by ultraviolet (UV) light is deficient,
 CLINICAL MANIFESTATION
Slow growing, rarely affect the deeper tissue because of fascia whict act
as barrier. At advanced stage, it could develop into orbita, paranasal sinus,
nasal cavityand cranial cavity.
Painless
Epiphora , could happen in basal cell carcinoma which located in canthus
internus where tumors infiltrated puncta and nasolacrimal duct.
Reduced visual acuity into blindness. On further growth, tumor will impair
lower and upper eyelid and enter to orbital space. This will cause exposure
keratitis due to non functioned upper eyelid, and continue become
cornea ulcer to endophtalmitis.
Basal Cell Carsinoma
 Treatment
Surgical therapy is the treatment of choice. Tumor that limited in the eyelid
will have a reconstruction. Excision made with a margin of 45 mm. tumors
that invade the orbit will undergo exenteration surgery
Radiation therapy can be used in patients with advanced and extended
lesions, as well as in those for whom surgery is not suitable and will cause
damage to the function of the eyelid. Radiation therapy is used to shrink
the size of tumor to a smaller size before reconstruction and not make any
disturbance of eyelid function,
 Squamous cell carcinoma
Squamous cell carcinoma is a non-melanotic malignant skin tumor
originates from the growth of epidermis squamous cell of palpebra. Squamous
cell carcinoma divided into insitu neoplasia when there are already an
invasion across basalis palpebra
SCC incidence variating based on geographic, race, ages, associated
with HIV/AIDS.
SCC dominantly affect caucasian race. Conjunctival squamous cell
carcinoma mostly affect man(75%) than woman (25%) and tend to affect
older ages.
 Etiology dan Risk factor

Etiologiy of SCC still unknown, but it postulated that there is an abnormal

maturation of conjunctiva epithelial due to the cobination of some risk
factor:
Exposure to excessive ultra violet.
HPV type 16 dan l8, known could cause dysplasia at squamous epithe.
Individu with positive HIV dan Xeroderma Pigmentosum patient.
In xeroderma pigmentosum, occur congenital disorder of DNA repair in
which the ability to repair damage caused by ultraviolet (UV) light is
deficient
 Clinical feature
There are many variation of SCC clinical features. There are 3 typeof clinical
features :
Leukoplakic lesion; Appears as thickening of squamous layer with white
hyperkeratosis plaques. (A)
Papillomatous lesion; Appears as tender mass with many vascularisation.(B)
Geltinosa lesion; Appears as thickening of gelationasa layer with unclear
margin, which is not as clear as leukoplakic lesion or papillomatous lesion.

Karsinoma
sel skuamosa
pada konjungtiva
 Treatment
Treatment of choice of conjunctival squamous cell carcinoma is wide
excision. The margin recommended to be 2-3 mm from tumor margin.
Frozen section could assess the lateral surgical margins, but is not helpful
with the deep margins. Cryosurgery could be done after surgical excision
at left conjunctiva margin, and base of lesion to decrease recurrence rate,
Cryotherapy can destroy tumor cells by frozen disruption as well as local
ischemia.
Radiation can be use as adjuvant therapy in wide lesion with unclear
margin and as paliatif treatment at untolerated case by surgical
 TUMOR IN RETINA
Renitoblastoma
Retinoblastoma is the most common primary ocular malignancy of
childhood and is a neuroblastic tumor.
Retinoblastoma is the most common intraocular tumor in baby and
children accounting for 3% of all childhood cancers. Bilateral
retinoblastoma case typically diagnosed at first year of ages in family and
at unilateral sporadic case, it diagnosed between age 1-3 years old
Frequency of Retinoblastoma 1:14.000 to 1:20.000 of live birth depends on
the country
 Epidemiologi
The most common intraocular tumor in childhood
The third intraocular tumor after melanoma and metastasis from all of the
population
Insidence : 1:14.000 1:20.000 live birth
90% found before 3 years old
Can affect both man and woman
Can affect on left and right eye
No race predilectin
60%-70% unilateral (average age when diagnoses is 24 months)
30%-40% bilateral (average age when diagnoses is 14 months)
 Etiology
Retinoblastoma is caused by RB1 gene mutations, which located at
chromosome 13q14 and protein code pRB that helps supress tumor formation.
pRB is a nukleoprotein which located at DNA (Deoxiribo Nucleid Acid) and
controll the cell cycle at transition phase in G1 to S. so it will cause malignant
change from primitive retina cell before the differentiation is over.
 Clinical Manifestation
< 5 years old patient
Leukokoria (54%-62%),
Strabismus (18%-22%)
Hipopion
Hifema
Heterokromia
Spontaneous globe perforation
> 5 years old patient
Leukokoria (35%)
Decreased visual acuity (35%)
Strabismus (15%)
 Pemeriksaan Penunjang
Examination of fundus oculi found elevated mass lesion from retino with
vascularisation on the surface or in the tumor mass with blur margin
X-rays examination, almost 60-70% show calcification. If tumor infiltrate to
optic nerve, optic foramen widened
USG, with this examination, it could detect intraocular mass
Lactic acid dehydrogenase (LDH), by comparing aquoeus humor LDH level
with blood serum. If the rasio is bigger than 1,5 , it suspected intraocular
retinoblastoma (in normal condition, ratio is less than 1)
 Treatment (1)
Enukleation : Enukleation considered as approriate intervention, if :
1.Tumor involve more than 50% of eye ball.
2.Suspected of involvemen orbita and opticus nerve
3.Involve anterior segmen with or without neovaskular glaucoma
Orbital exenteration : Orbital exenteration implies removal of the
orbital content along with the periosteum
Chemotherapy : systemic chemotherapy will reduce the tumor size, then
could use focal combination, such as laser therapy. Nowadays, there are a
lot combination of regimen, such Carboplatin, Vincristine, Etoposide dan
Cyclosporine. Child who get chemotherapy drug by intravenous every 3-4
weeks for 4-9 cycle of chemotherapy.
 Treatment (2)
Photocoagulation and Hyperthermia : Xenon and Argon Laser (532 nm)
straditionally used to retinoblastoma which have apex height less than 3
mm with basal dimension les than 10 mm, 2-3 exposure times.
Photocoagulation will destruct blood supply of tumors, then will undergo
regression. Bigger laser could use for direct therapy on tumor surface.
Diode laser (8-10 mm) used as hyperthermia. Direct use on tumor surface
will make tumor temperature add into 45-60oC and have sitotoxic effect
that could increase by chemotherapy and radiation
Cryotherapy :Effective for tumor with basal dimension size less than 10 mm
and 3 mm atipical thickness. Cryotherapy uses direct visualization with Triple
Freeze-Thaw Technique. Especially laser photoablation choosed for
posteriorly located tumor and cryoablation for anteriorly located tumor.
But, recurrent tumor often needs both technique.
 Daftar Pustaka
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