Orbital Tumors in the Older Adult

Population
Hakan Demirci, MD,1 Carol L. Shields, MD,1 Jerry A. Shields, MD,1 Santosh G. Honavar, MD,1
Gary J. Mercado, MD,2 Jose C. Tovilla, MD1

Purpose: To determine the types and frequency of orbital tumors in the older adult population.
Design: Retrospective consecutive case series.
Participants: Two hundred consecutive patients aged 60 years or older with an orbital tumor managed at a
tertiary referral center.
Main Outcome Measures: The relative incidence and management of orbital tumors in patients aged 60
years or older.
Results: Of approximately 950 consecutive patients with orbital space-occupying lesions managed over a
25-year period on the Oncology Service, 200 patients (21%) were 60 years or older at the time of diagnosis. The
orbital tumor was unilateral in 183 patients (92%) and bilateral in 17 patients (8%). The most common clinical
features at presentation included mass in 51 patients (26%), proptosis in 36 (18%), and pain in 30 (15%). The
mean duration of symptoms was 11 months before referral. The orbital tumor was malignant in 125 patients
(63%) and benign in 75 (27%). The most common diagnoses were malignant lymphoma in 47 patients (24%),
idiopathic orbital inflammation in 19 (10%), and cavernous hemangioma in 15 (8%). The diagnosis was made with
clinical findings and imaging studies in 58 patients (29%) and additional histopathologic examination in 142
patients (71%). Of 217 tumors, the main tumor location was in the superior half of the orbit in 106 lesions (49%),
in the anterior orbit in 100 (46%), and in the extraconal space in 135 (62%). Imaging studies showed a mass with
well-defined margins in 90 tumors (41%) and ill-defined margins in 127 (59%). The tumors were solid in 203 cases
(94%), cystic in 6 (3%), and mixed in 8 (3%). Over a mean of 31 months follow-up, 50 (25%) patients had orbital
tumor–related systemic involvement (metastasis or lymphoma), and 150 (75%) remained free of systemic
involvement.
Conclusions: Orbital tumors in the senior adult population are malignant in 63% of cases. Malignant
lymphoma is the most common tumor in this age group, accounting for 24% of cases. Overall, 25% of patients
have systemic problems related to the orbital process develop, so systemic evaluation is warranted.
Ophthalmology 2002;109:243–248 © 2002 by the American Academy of Ophthalmology.

Orbital tumors represent a varied group of lesions, including
primary, secondary, and metastatic tumors.1,2 The types and
frequencies of orbital tumors cited in studies vary according
to the source, whether it is from a pathology department,
clinical ophthalmology service, neurosurgical department,
or from different geographic areas.3–9 For example, in a
survey of 645 orbital lesions from the pathology laboratory
at Wills Eye Hospital, Shields et al3 reported that cystic
Originally received: November 3, 2000.
Accepted: March 18, 2001. Manuscript no. 200752.
1
Oncology Service, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania.
2
Department of Ophthalmology and Visual Sciences, Philippine General
Hospital, University of the Philippines, Manila, Philippines.
Presented at the annual meeting of the American Academy of Ophthal-
mology, New Orleans, Louisiana, November, 2001.
Supported by the International Award of Merit in Retina Research, Hous-
ton, Texas (JAS), Andres Soriano Cancer Research Foundation, Manila,
Philippines (GJM), Orbis International, New York, New York (SGH),
Hyderabad Eye Research Foundation, Hyderabad, India (SGH) and the Eye
Tumor Research Foundation, Philadelphia, Pennsylvania (CLS).
Reprint requests to Carol L. Shields, MD, Oncology Service, Wills Eye
Hospital, 900 Walnut St., Philadelphia, PA 19107.
orbital tumors, particularly the dermoid cyst, were the most
common biopsied orbital masses, accounting for 52% le-
sions that were excised or biopsied. Conversely, in a review
from a clinical ophthalmology department of 1409 orbital
lesions, Rootman4 observed that Graves’ orbitopathy was
the most common space-occupying orbital lesion, found in
48% cases, including those that were not biopsied. Thus, the
source of information can influence a general orbital tumor
survey.
The age of the studied cohort is also an important factor
affecting relative incidence of orbital tumors. Although the
dermoid cyst is the most common orbital mass in children,
accounting for 50% of all orbital tumors in the pediatric
population,10 this tumor is rarely found in the senior adult
population.4 Cavernous hemangioma and lymphoma are far
more common in young to middle-aged adults, accounting
for 7% and 5% of primary orbital tumors, respective-
ly.3,6,7,10 –12 In addition, there is some evidence that senior
adults may manifest an array of more malignant orbital
tumors than do middle-aged adults or children.3,6,7 With
increasing age, orbital tumors become more common.13 The
age-specific incidence of a primary malignant orbital tumor
is approximately 2/million population until the sixth decade

© 2002 by the American Academy of Ophthalmology ISSN 0161-6420/02/$–see front matter 243
Published by Elsevier Science Inc. PII S0161-6429(01)00932-0
 Ophthalmology Volume 109, Number 2, February 2002

of life, when it increases to 4/million population in those Table 1. Clinical Characteristics of 200 Consecutive Adult
older than age 60 years and further increases to 10/million Patients Age 60 Years or Older with Orbital Tumors
population in those older than age 80 years.13
Clinical Features Number (%)*
There is limited information in the literature about the
spectrum of orbital tumors in the senior adult population Initial symptoms and signs
aged 60 years or older. This sector of the population is Mass (palpable or visualized) 51 (26)
Proptosis 36 (18)
growing steadily and is predicted to increase even more in Pain 30 (15)
the near future. In this study, we review our experience with Blurred vision 20 (10)
200 consecutive patients aged 60 years or older and discuss Red eye 19 (10)
the clinical array of tumors in this select group of patients. Ptosis 17 (9)
Diplopia 16 (8)
Asymptomatic 11 (6)
Visual acuity
Materials and Methods 20/20–20/40 151 (76)
20/50–20/400 21 (10)
The medical records of all patients with the diagnosis of orbital CF-NLP 28 (14)
Orbit location (sector)
space-occupying lesion managed on the Ocular Oncology Service
Superotemporal 56 (26)
at Wills Eye Hospital, Philadelphia, Pennsylvania, between Janu- Superior 25 (12)
ary 1974 and April 2000 were identified. All patients aged 60 years Superonasal 25 (12)
or older at the time of initial examination were included in this Temporal 20 (9)
study. The diagnosis was made with orbital biopsy in available Nasal 16 (7)
cases and, if not available, with the clinical findings and imaging Inferior 16 (7)
studies (computed tomography, magnetic resonance imaging). The Inferonasal 11 (5)
frequency of the various orbital lesions was calculated using our Inferotemporal 10 (5)
classification system of orbital tumors, which has been previously Central 21 (10)
Diffuse 17 (8)
published.2,3
Orbit location (anterior posterior)
The data collected at initial patient evaluation in our office Anterior 100 (47)
included patient data such as age, gender (female, male), race Middle 72 (32)
(African American, Hispanic, Asian, Caucasian), the presence of Posterior 45 (21)
any systemic cancer, and date of diagnosis of systemic cancer. The Orbit location (coronal)
initial symptom and its duration were recorded. The ocular data Extraconal 135 (62)
included laterality (bilateral, unilateral), affected eye (right eye, Intraconal 66 (30)
left eye), and best-corrected Snellen visual acuity. The tumor data Both 16 (7)
included the method of diagnosis (based on histopathologic exam-
ination or clinical findings and imaging studies), orbit quadrant * Total % is more than 100% because of rounding.
location (superior, nasal, inferior, temporal, central, diffuse), orbit CF-NLP ⫽ Counting fingers to no light perception.
anteroposterior location (anterior, middle, posterior), relationship
to muscle cone (intraconal, extraconal, both), and lacrimal gland
involvement (present, absent). The features evaluated on imaging
The clinical features of the orbital tumors are shown in Table 1.
studies were appearance (ill-defined, well-defined), consistency
The main clinical features at presentation included mass (palpable
(solid, cystic, mixed), and configuration (round, ovoid, diffuse).
or visualized) in 51 patients (26%), proptosis in 36 (18%), and pain
The management of tumor (observation, excisional biopsy, inci-
in 30 (15%) (Table 1). The mean duration of symptoms and signs
sional biopsy, enucleation, exenteration, external beam radiother-
was 11 months (median, 3 months; range, 0 –240 months). The
apy, systemic chemotherapy, plaque radiotherapy, systemic corti-
orbital lesion was unilateral in 183 patients (92%) and bilateral in
costeroid, and any combination of these treatments) was assessed.
17 (8%). The tumor involved the right eye in 89 cases (45%) and
Follow-up data were collected regarding the development of any
the left eye in 94 cases (47%). In 17 cases (87%) the tumor was
systemic cancer or related disease, date of diagnosis of systemic
bilateral. The visual acuity was better than 20/50 in 151 patients
problem, and the patient outcome (alive and well, alive with
(76%) (Table 1). The diagnosis was made with the clinical findings
systemic lymphoma, alive with metastasis, dead from metastasis,
and imaging studies (computed tomography, magnetic resonance
dead from other cause).
imaging) in 58 patients (29%) and additional histopathologic ex-
amination in 142 patients (71%).
Classification of 200 consecutive adult patients aged 60 years
Results or older with orbital tumors is shown in Table 2. Subclassification
of orbital tumors is demonstrated in Tables 3 to 10. The most
Of approximately 950 consecutive patients with orbital space- common primary orbital tumor was malignant lymphoma in 47
occupying lesions examined on the Ocular Oncology Service over patients (24%). The other common primary orbital tumors were
a 25-year period, 200 patients (21%) were age 60 years or older at idiopathic orbital inflammation in 19 patients (10%), cavernous
the time of diagnosis. The mean age at the time of diagnosis was hemangioma in 15 (8%), benign reactive lymphoid hyperplasia in
72 years (median, 70 years; range, 60 –92 years). There were 114 7 (4%), optic nerve meningioma in 5 (3%), and sphenoid wing
females (57%) and 86 males (43%); 187 Caucasian (93%), 9 meningioma in 5 (3%). The orbital tumor was malignant in 125
African American (5%), 3 Asians (2%) and 1 Hispanic (⬍1%). patients (63%) and benign in 75 patients (27%).
There were 40 patients (20%) who had systemic cancer diagnosed The three most common tumors in the anterior orbit were
a mean of 56 months (median, 33 months; range, 0 –348 months) malignant lymphoma in 29 of 86 patients (34%), secondary orbital
before our examination, of which 25 (13%) had carcinoma and 15 tumor from conjunctival melanoma in 12 (14%), and idiopathic
(8%) had lymphoma. orbital inflammation in 8 (9%). The three most common tumors in

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 Demirci et al 䡠 Orbital Tumors in Older Adults

Table 2. Classification of 200 Consecutive Adult Patients Aged Table 4. Subclassification of 28 Patients with Vasculogenic
60 Years or Older with Orbital Tumors Lesions among 200 Consecutive Older Adult Patients with
Orbital Tumor
Category Number of Patients (%)*
(% of (% of Total
Cystic lesion 6 (3) Number Vasculogenic Orbital
Vasculogenic lesion 28 (14) Subcategory of Patients Lesions) Lesions)
Optic nerve and meningeal tumor 10 (5)
Osseous tumor 1 (⬍1) Cavernous hemangioma 15 (54) (8)
Adipose tissue lesion 1 (⬍1) Varices 4 (14) (2)
Lacrimal gland lesion 6 (3) Lymphangioma 4 (14) (2)
Primary melanocytic tumor 2 (1) Hemangiopericytoma 3 (11) (2)
Metastatic tumors to the orbit 20 (10) Arteriovenous malformation 1 (4) (⬍1)
Lymphoid tumor and leukemia 56 (28) Intravascular papillary 1 (4) (⬍1)
Secondary orbital tumor endothelial hyperplasia
Eyelid origin 14 (7)
Conjunctival origin 15 (8)
Intraocular origin 11 (6)
Paranasal sinus origin 7 (4) had a documented systemic cancer before the diagnosis of the
Parotid gland origin 1 (⬍1) orbital tumor. In those three patients with no prior diagnosis of
Inflammatory lesion 22 (11) systemic cancer, workup revealed a primary lung adenocarcinoma
in 1 patient, neuroendocrine tumor in 1, and no primary site could
* Total % is more than 100% because of rounding.
be found in 1 patient.
Primary management of the orbital tumor in 200 patients is
shown in Table 11. The patients were followed for a mean of 31
months (median, 15 months; range, 1–173 months) after the first
the middle portion of the orbit included malignant lymphoma in 14 treatment. At last visit, 114 patients (57%) were alive and well, 25
of 71 patients (20%), metastatic orbital tumor in 12 (17%), and (13%) alive with systemic lymphoma, 18 (9%) alive with systemic
cavernous hemangioma in 11 (15%). The three most common metastasis, 32 (16%) dead from systemic metastasis or lymphoma,
tumors in the posterior orbit were optic nerve sheath meningioma and 11 patients (6%) were dead from other causes.
in 5 of 43 patients (12%), sphenoid wing meningioma in 5 (12%),
and cavernous hemangioma in 5 (12%). There were 17 patients
with bilateral tumors, and these most often represented lymphoid
tumors in 14 patients (82%), leukemia in 1 (6%), idiopathic orbital Discussion
inflammation in 1 (6%), and secondary tumor from ethmoid sinus
adenocarcinoma in 1 patient (6%). There have been a number of reported large series that
Of the total 217 orbital tumors, the main tumor location was in review orbital tumors in the general population and partic-
the superior half of the orbit, including superonasal and supero- ularly in children. However, the spectrum and relative in-
temporal quadrants in 106 tumors (53%), in the anterior orbit in cidence of orbital tumors, specifically in the older popula-
100 (46%), and in the extraconal space in 135 tumors (62%) (Table
1). Imaging studies showed that the tumor had ill-defined margins
tion, has been overlooked.3–20 According to the Census
in 127 (59%) cases and well-defined margins in 90 (41%). The Bureau, older adults, age 60 years or greater, represent
consistency of the tumor was solid in 203 lesions (94%), cystic in approximately 25% of the population, and this faction of the
6 (3%), and mixed in 8 (3%). The shape of tumor was round in 50 population continues to increase. The projected annual
lesions (23%), ovoid in 56 (26%), and diffuse involvement of orbit growth of the elderly population will be 1.3% between 1990
was present in 109 (51%). Bone changes included erosion in 12 and 2010 and 2.8% between 2010 and 2030. Conversely, the
lesions (6%), expansion in 3 (1%), and hyperostosis in 3 (1%). annual growth of the general population will be 0.9% and
Lacrimal gland involvement was found in 35 patients (18%). 0.7% during the same periods. Epidemiologic studies reveal
Among 56 patients with malignant lymphoma and lymphoid that the average survival of a male in the United States is
hyperplasia, systemic lymphoma was present in 15 patients (27%) presently 73 years and of a female is 79 years. For children
for a mean 41 months (median, 15 months; range, 0 –109 months)
before the diagnosis of the orbital tumor. In 15 patients (27%), the
born in the year 2000, it is expected that the average
systemic lymphoma developed at a mean of 20 months (median, 5 survival will increase to 78 years for males and 83 years for
months; range, 0 –101 months) after the diagnosis of the orbital females. This important information emphasizes our need to
tumor. Among the 20 patients with orbital metastasis, 17 (85%) understand diseases of the growing senior adult population
and was the stimulus for this investigation. This is the first
Table 3. Subclassification of Six Patients with Cystic or
Cystlike Lesions among 200 Consecutive Older Adult Patients Table 5. Subclassification of 10 Patients with Optic Nerve and
with Orbital Tumor Meningeal Tumors among 200 Consecutive Older Adult
Patients with Orbital Tumor
(% of (% of Total
Number Cystic Orbital (% of Optic
Subcategory of Patients Lesions) Lesions) Nerve and (% of Total
Number Meningeal Orbital
Dermoid cyst 2 (33) (1) Subcategory of Patients Tumors) Lesions)
Hematocele 2 (33) (1)
Mucocele 1 (17) (⬍1) Optic nerve meningioma 5 (50) (3)
Epithelial inclusion cyst 1 (17) (⬍1) Sphenoid wing meningioma 5 (50) (3)

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 Ophthalmology Volume 109, Number 2, February 2002

Table 6. Subclassification of Six Patients with a Lacrimal Table 8. Subclassification of 56 Patients with Lymphoid
Gland Lesion among 200 Consecutive Older Adult Patients Tumors and Leukemia among 200 Consecutive Older Adult
with Orbital Tumor Patients with Orbital Tumor

(% of (% of (% of Total
Lacrimal (% of Total Number Lymphoid Orbital
Number Gland Orbital Subcategory of Patients Lesions) Lesions)
Subcategory of Patients Lesions) Lesions)
Malignant lymphoma 47 (84) (24)
Chronic dacryoadenitis 2 (33) (1) Benign reactive lymphoid 7 (12) (4)
Pleomorphic adenocarcinoma 2 (33) (1) hyperplasia
Epithelial cyst 1 (17) (⬍1) Leukemia 1 (2) (⬍1)
Adenoid cystic carcinoma 1 (17) (⬍1) Plasmacytoma 1 (2) (⬍1)

report of its kind to focus specifically on orbital tumors in various orbital tumors is critical to patient evaluation and
older adults. management.
Several major differences are noted when comparing There was also a change in the subclassification of tumor
orbital tumors in older adults with those in the general type in each tumor category, depending on patient age
population and those in children. The relative incidence of (Tables 3–10). For example, the main vascular tumor in
malignant tumors overall, such as lymphoid tumors, sec- children has been found to be capillary hemangioma (4%).
ondary tumors from adjacent structures, and metastatic tu- However, in the older population, there were no cases with
mors, is more common in the older population, whereas the capillary hemangioma, and the main vasculogenic tumor
relative incidence of cystic tumors and optic nerve and was cavernous hemangioma (8%).10 A similar change was
meningeal tumors is much less common. There was no observed in optic nerve and meningeal tumors. Juvenile
substantial change in the relative incidence of inflammatory pilocytic astrocytoma accounted for 2% of orbital tumors in
disease, vasculogenic tumors, or thyroid orbitopathy with children, but in the older population, glioma was not ob-
age (Table 12, 13). served in any case.10 Sphenoid wing meningioma was found
The most notable differences between patients younger only in middle-aged and older patients (3%); there were no
than and older than 60 years were with regard to the fre- meningiomas in children.
quency of lymphoid tumors. They account for 3% of orbital A general observation is that the incidence of malignant
tumors in children, 8% in the general population, and 28% tumor increases with age. Of 557,508 cases of systemic
in older adults (Table 12, 13).3–20 The specific relative cancer diagnosed between 1992 and 1996 in the United
incidence of secondary orbital tumors from adjacent struc- States, 1% of patients were children (⬍20 years old), 40%
tures has been found to be at 5% in children, 11% in the were between 20 and 65 years old, and 59% were senior
general population, and 21% in the older adult population adults older than 65 years of age.21 Similarly, the most
(Table 12, 13).3–20 A similar but less pronounced increase serious finding in our analysis was the markedly high inci-
was observed also with regard to orbital metastatic tumors, dence of malignant tumors among senior adults. Of 1588
which represent only 5% in children, 3% in the general published cases in series of orbital tumor in children, the
population, and 8% in the older population (Table 12, incidence of malignant tumors was approximately 22%,
13).3–20 Conversely, a decrease in the relative incidence of with a range of 10% to 43% in different studies from
cystic tumors from 28% in children and 12% in the general
population to 6% in the older population was observed
(Table 12, 13).3–20 Likewise, there was a similar decrease in Table 9. Subclassification of 48 Patients with Secondary
the relative incidence of optic nerve tumors from 11% in Orbital Tumors from Adjacent Structures among 200
Consecutive Older Adult Patients with Orbital Tumor
children to 5% in the general and older population (Table
12, 13).3–20 Understanding the relative incidence of these (% of (% of Total
Number Secondary Orbital
Subcategory of Patients Lesions) Lesions)
Table 7. Subclassification of 20 Patients with Orbital
Metastatic Lesions among 200 Consecutive Older Adult Eyelid origin
Patients with Orbital Tumor Squamous cell carcinoma 4 (9) (2)
Malignant melanoma 3 (6) (2)
(% of Sebaceous carcinoma 3 (6) (2)
Number Metastatic (% of Total Basal cell carcinoma 2 (4) (1)
Primary Site of Patients Lesions) Orbital Lesions) Merkel cell carcinoma 2 (4) (1)
Conjunctival origin
Breast 9 (45) (4) Malignant melanoma 14 (29) (7)
Prostate 3 (15) (2) Squamous cell carcinoma 1 (2) (⬍1)
Lung 2 (10) (1) Intraocular origin
Kidney 2 (10) (1) Uveal melanoma 11 (23) (6)
Skin 1 (5) (⬍1) Paranasal sinus origin
Neuroendocrine tumor 1 (5) (⬍1) Maxillary sinus carcinoma 5 (11) (3)
Carcinoid tumor 1 (5) (⬍1) Ethmoid sinus carcinoma 2 (4) (1)
Undetermined 1 (5) (2) Parotid gland origin 1 (2) (⬍1)

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 Demirci et al 䡠 Orbital Tumors in Older Adults

Table 10. Subclassification of 22 Patients with Inflammatory different origins (Table 3).10 –12,14 –20 Of approximately
Lesions among 200 Consecutive Older Adult Patients with 4250 orbital tumors in the general population, the incidence
Orbital Tumor of malignant tumors was approximately 25%, with a range
(% of of 21% to 34% in different series (Table 12).3–12 However,
(% of Total the malignant tumors in the senior adult population were
Number Inflammatory Orbital more common, accounting for 63% of all tumors. This
Subcategory of Patients Lesions) Lesions) higher incidence may result from a higher number of lym-
Idiopathic orbital inflammation 20 (90) (10) phomas in our series or may reflect the referral bias to our
Aspergillosis 1 (5) (⬍1) ocular oncology center.
Wegener’s granulomatosis 1 (5) (⬍1)
Lymphoma is usually discovered in older people. Of
22,144 cases of systemic non-Hodgkin’s lymphoma cases
diagnosed between 1992 and 1996 in the United States, 2%
of patients were younger than 20 years old, 46% were
between 20 and 65 years old, and 52% were older than 65
years old.21 Similarly, malignant orbital lymphoma was
much more common in the older adult population (24%)
compared with children (⬍4%) and the general population
Table 11. Primary Management* of 200 Consecutive Older
(⬍8%).
Adult Patients with Orbital Tumors
In conclusion, it is evident that orbital tumors in the older
No of patients adult population are more malignant and more commonly
Management (%)* associated with systemic processes than those in the general
Observation 41 (21) population or in children. Of all orbital tumors in senior
Surgical resection 54 (27) adults, 63% were malignant, 10% of patients had or devel-
Orbital exenteration 39 (20) oped related systemic cancer, 15% had or developed related
Radiotherapy 47 (24)
Chemotherapy 9 (5) systemic lymphoma, and 16% died from related systemic
Corticosteroids 10 (5) disease. Lymphoid tumors, secondary tumors, and meta-
static tumors increase with age, whereas cystic orbital le-
*Some patients may have had more than one form of management. sions decrease with age. Malignant lymphoma is the most
common tumor in senior adults, accounting for 24% of all
cases. It is important to anticipate this when examining an
older patient with an orbital tumor. Evaluation for systemic
carcinoma and systemic lymphoma may be necessary in
these situations. Based on this report, the clinician may be
better able to anticipate what orbital tumors are likely in

Table 12. Published series of orbital tumors in the general population

Classification Shields3 Henderson7 Rootman4 Wilson5 Kennedy8 Seregard6 Total

Thyroid Orbitopathy NA NA 47% NA 6% NA 17%
Cystic lesions 30% 12% 6% 9% 11% 12% 12%
Vasculogenic lesions 6% 15% 7% 5% 9% 12% 9%
Peripheral nerve tumors 2% 4% 2% 4% 4% 3% 3%
Optic nerve and meningeal tumors 2% 11% 4% 1% 5% 2% 5%
Fibrocytic tumors 2% 13% ⬍1% ⬍1% ⬍1% 1% ⬍1%
Osseous and fibro-osseous 2% 3% 2% 1% 3% ⬍1% 3%
Cartilaginous lesions ⬍1% ⬍1% ⬍1% NA NA ⬍1% ⬍1%
Mesenchymal and adipose lesions 4% ⬍1% ⬍1% 2% ⬍1% 5% 2%
Rhabdomyosarcoma 1% 2% ⬍1% 4% 1% 1% 1%
Lacrimal gland lesions 13% 6% 1% 3% 5% 18% 6%
Primary melanocytic tumors ⬍1% ⬍1% NA NA NA ⬍1% ⬍1%
Metastatic lesions 3% 2% 2% 5% 3% 4% 3%
Lymphoid tumors and leukemias 10% 8% 4% 5% 13% 13% 8%
Secondary tumors 11% 23% 3% 29% 6% 11% 11%
Histocytic lesions ⬍1% 1% ⬍1% 1% ⬍1% 1% ⬍1%
Inflammatory lesions 13% 8% 10% 17% 16% 6% 12%
Unclassified lesions 2% NA ⬍1% 5% 2% 9% 2%
Normal ⬍1% NA NA 5% ⬍1% NA ⬍1%
Other NA NA 11% NA 15% NA 6%
Total 645 764 1409 311 820 300 4249

NA ⫽ Not-applicable

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 Ophthalmology Volume 109, Number 2, February 2002

Table 13. Published series of orbital tumors in children

Eldrup- Iliff/
16
Lesion Ingalls14 Porterfield15 MacCarty Jorgensen18 Green19 Crawford20 Shields10 Bullock11 Kodsi21 Total
Cystic lesions 29% 12% 2% 48% 35% 4% 52% 42% 23.2% 26%
Vasculogenic lesions 28% 13% 19% 8% 16% 16% 7% 16% 17.6% 15%
Peripheral nerve tumors 12% 3% 3% 4% 6% 9% 2% 6% 5.3% 5%
Optic nerve and meningeal tumors 6% 18% 27% 11% 8% 11% 2% 5% 16.5% 13%
Osseous, fibro-osseous and cartilagenous NA ⬍1% 11% 1% 2% 4% 1% 5% 7.9% 4%
Mesenchymal and adipose lesions NA 1% ⬍1% 4% 3% NA 7% 8% 1.2% 3%
Rhabdomyosarcoma 8% 26% NA 13% 9% 9% 4% 2% 7.1% 9%
Lacrimal gland lesions NA 2% 1% 3% 3% ⬍1% 2% 2% 1.8% 2%
Primary melanocytic tumors NA NA 1% NA NA NA NA NA NA ⬍1%
Secondary/Metastatic tumors 6% 1% 6% 3% 6% 9% 4% 3% 6.8% 5%
Lymphoid tumors and leukemia 6% 6% ⬍1% 5% 1% 15% 2% 4% 1.5% 4%
Histiocytic and related NA ⬍1% NA NA ⬍1% 13% ⬍1% 2% 1.2% 2%
Inflammatory lesions 4% 5% 9% 1% 5% 9% 16% 4% 8.5% 8%
Other 2% 11% 18% 1% 6% NA NA 1% 1.5% 5%
Total 51 214 186 80 174 152 250 141 340 1588

NA ⫽ Not applicable.

older adults and provide more focused diagnostic and ther-
apeutic care.
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