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Orbital Metastasis: Clinical Features, Management and Outcome 

Authors: Alejandra A. Valenzuelaa; Curtis W. Archibalda; Ben Flemingb; Lorraine Ongc; Brett O'Donnelld; John Crompton Je; Dinesh Selvae; Alan A. McNabc; Timothy J. Sullivanb
Affiliations:   a Orbital, Lacrimal and Oculoplastic Clinic, Department of Ophthalmology & Visual Sciences, QEII Health Sciences Centre, Dalhousie University, Halifax, Canada
b Eyelid, Lacrimal and Orbital Clinic, Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
c Orbital, Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
d Departments of Ophthalmology, Royal North Shore Hospital and St Vincent's Hospital, Sydney, Australia
e South Australian Institute of Ophthalmology and Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, Australia
DOI: 10.1080/01676830902897470
Publication Frequency: 6 issues per year
Published in: journal Orbit, Volume 28, Issue 2 & 3 April 2009 , pages 153 - 159
Subject: Ophthalmology;
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Abstract

Purpose: To review the clinical features, treatment, outcome and survival of metastatic tumors of the orbit. Materials and Methods: Retrospective, non-comparative, chart review of 80 patients with orbital metastasis treated in four tertiary orbital centres in Australia. Results: The study included 80 patients of which, 44 were male with a mean age of 60 years. Orbital involvement commonly presented late in a multisystemic disease; however, the orbit was the first presentation in 15% of the cases. Diplopia (48%), pain (42%), and visual loss (30%) were the commonest symptoms at presentation; whereas proptosis (63%), strabismus (62%), and visual loss (41%) were the most frequent clinical signs. Computed tomography commonly showed a solid enhancing mass (42 cases) located within the orbital fat (43%), or enlarging an extraocular muscle (28%). Breast carcinoma (29%), melanoma (20%), and prostatic cancer (13%) were the most frequent histological types. Treatment was often multi-disciplinary and modalities included radiotherapy, chemotherapy, hormone therapy, surgery, and immunotherapy. Survival was limited to 1.5 years after diagnosis independent of the histological type, with 29% of patients alive after 17 months follow-up. Conclusions: A high index of suspicion and appropriate intervention with histological diagnosis can help in the management and quality of life in patients with metastatic orbital disease. Overall survival is limited and we encountered statistical limitations proving differences in the survival based on the sub-type of primary tumour involved. Metastatic orbital melanoma presented a higher incidence when compared with previous studies, probably due to the increase frequency of skin found in the Australian population.
Keywords: orbital tumors; metastasis; histopathology; management
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