OP2.7-8 | Orbital Tumours: Classification, Presentation, Workup and Referral — Summary & Reflection

KEY TAKEAWAYS

Orbital tumours are classified by origin (primary, secondary, metastatic), biological behaviour (benign, malignant), patient age, and tissue of origin. In children, rhabdomyosarcoma is the commonest primary orbital malignancy — rapidly progressive extraconal proptosis requiring urgent biopsy and VAC chemotherapy + radiotherapy (>90% survival for localised disease). In adults, cavernous haemangioma is the commonest benign orbital tumour — slowly progressive axial proptosis with characteristic progressive gadolinium fill-in on MRI; managed conservatively or by lateral orbitotomy excision. Lacrimal gland tumours require the critical clinical distinction: painless + bone remodelling = pleomorphic adenoma (incisional biopsy CONTRAINDICATED; en bloc excision curative) vs painful + bone erosion = adenoid cystic carcinoma (biopsy required; poor prognosis). CT distinguishes bony remodelling (benign) from bony erosion (malignant). MRI characterises soft tissue and provides tumour-specific gadolinium patterns. Orbital lymphoma requires systemic staging; isolated MALT responds to radiotherapy. Optic nerve sheath meningioma is identified by optociliary shunt vessels and disproportionate vision loss. Universal management principles: corneal protection and serial colour vision monitoring. Red flag signs for urgent referral: rapid onset in a child, pain, bone erosion, visual loss, colour desaturation, RAPD.

REFLECT

Consider your approach to a patient referred to you with the words 'orbital mass on CT'. Before opening the imaging report, what clinical information would you want from the referrer — and why? How does each piece of information (patient age, time course, presence of pain, bilateral vs unilateral) change your pre-imaging differential? After seeing the imaging, what single finding would most change your urgency and your management plan? Reflecting on this module, identify one tumour type where you feel confident in your clinical approach and one where you would need to consult an orbital surgeon before making management decisions — this honest self-assessment is the foundation of safe clinical practice.