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.
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.
 ORBITS ANATOMI

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
3 Retina Retinoblastoma, Melanoma can originate from the
4 Bone Osteoma, Dermoid cyst, Epidermoid cyst structure inside or
5 Optic nerve seath Meningioma around orbital space.
6 Optic nerve Glioma, Neurofibroma There are intraorbital
7 Connective tissue Rhabdomiosarkoma classification based on
8 Blood metastasize Adult: Ca mammae, Ca bronchial tissue :
Child: Neuroblastoma, Sarkoma Ewing,
Leukemia, Tumor testikuler
 Benign Eyelid Tumor
Melanocytic nevi
Melanocytic nevi are benign neoplasms or hamartomas
composed of melanocytes, the pigment-producing cells that
constitutively colonize the epidermis.

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, soft and flat surface.
Active formation of nevi cells usually occurs at dermo-epidermal
junction.
Compound nevi : 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

Angiogenic factors might have important role at proliferation

phase and involution of hemangioma. 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
Cappillary hemangioma appear at a few days of birth. Strawberry nevus
seen as red mark that will grow bigger
Kavernosum hemangioma, 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
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.
Corticosteroid theraphy
Surgical theraphy
Laser theraphy
 Xanthelasma

Xanthelasma defined as cholesterol deposit under the skin with

yellow clear margin ussually at anterior surface of palpebra.
 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. 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.Carbon dioxide and argon laser abration
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
 CLINICAL MANIFESTATION

Slow growing, rarely affect the deeper tissue because of fascia

whict act as barrier.
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.
Basal Cell Carsinoma
 Treatment
Surgical therapy is the treatment of choice. Tumor that limited in
the eyelid will have a reconstruction.
Radiation therapy can be used in patients with advanced and
extended lesions, 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.
SCC incidence variating based on geographic, race, ages
SCC dominantly affect caucasian race.
 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 UV
HPV type 16 dan l8, known could cause dysplasia at squamous
epithel.
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
 Treatment
Treatment of choice of conjunctival squamous cell carcinoma is
wide excision. Cryosurgery could be done after surgical excision
at left conjunctiva margin, and base of lesion to decrease
recurrence rate.
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.
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.
 Epidemiologi
The most common intraocular tumor in childhood
90% found before 3 years old
Can affect both man and woman
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 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
Leukokoria
Strabismus
Hipopion
Hifema
Heterokromia
Decreased visual acuity
Strabismus
 EYE EXAMINATIONS
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
 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
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.
 Treatment (2)
Photocoagulation and Hyperthermia : Photocoagulation will
destruct blood supply of tumors, then will undergo regression.
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.
Thank You
 Daftar Pustaka
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2008. Page 251-303.
2. America Academy of Ophthalmology. Pediatric Ophthalmology and Strabismus in Basic and Clinical
Science Course. Section 6. 2008-09 : 390-99
3. American Cancer Society. 2012. Retinoblastoma.
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