Meningiomata comprise some I7 per cent. of all tumours of the central nervous system (Kernohan and Sayre, 1952; Reese, I963). Of 230 consecutive cases of expanding lesions of the orbit, Reese (I963) found only eleven (5 per cent.) to be intraorbital meningiomata-none of them lying free within the orbit.The large majority of these intraorbital meningiomata are secondary-that is they extend into the orbit from an intracranial site of origin (Van Buren, Poppen, and Horrax, I957). Primary intraorbital meningiomata are rare and most of them have an attachment to the sheath of the optic nerve.A comprehensive review was made by Craig and Gogela (I949), who collected a series of 35 cases of secondary orbital meningiomata and seventeen primary ones. Of the primary tumours nine were attached to the optic sheath, three arose from the optic foramen, and five were lying unattached to the sheath either within the muscle cone or outside it. These authors reviewed a few previously reported cases. More recently single cases of free-lying orbital meningiomata have been reported by D'Alena (i 964) and Tan and Lim (I965).The case reported here is of interest in two respects: (i) It presented without the usual clinical features of visual defect or proptosis, so that the diagnosis was not suspected until histological sections had been examined.(2) It was one of those primary meningiomata which at operation appeared to be unattached to other orbital structures. Case reportA 20-year-old female student was seen in the Eye Department of the Royal Infirmary, Edinburgh, on October i69 I967, complaining of a swelling in the right lower lid, associated with epiphora, which had been present for a little more than a year.Examination An anterior orbital swelling was seen in the outer part of the right lower lid. The mass was firm and completely mobile and on its surface, which projected into the lower fornix, large vessels were visible (Fig. I, overleaf).Visual acuity was normal in each eye and there was no clinical proptosis, but it was possible to elicit diplopia on extreme downward gaze. X rays taken at this time of the orbits and skull were reported to be normal.Progress The lesion was observed over a period of 6 months by which time it was larger and was causing diplopia in the primary position. Hess screen examination now showed limitation in the
The purpose of this paper is to report six cases of choroidal metastases from breast primaries, which were referred to the Ophthalmic Clinic, Royal Infirmary of Edinburgh, between 1959 and I968. The emphasis is on the treatment of these patients, giving, where possible, quantitative assessment of visual function before and after conservative therapy. It is also the intention to show that the survival time, i.e. the time between the diagnosis of the choroidal metastases and death, may make such treatment worthwhile. Tables I and II. Three patients (Cases 2, 4, and 6) were noted to have widespread secondaries before the choroidal metastases were seen; one (Case 6) was seen terminally, and the eye was enucleated post mortem and confirmed the clinical diagnosis. Present study The clinical details of six patients are shown inFive patients received treatment. Four (Cases I, 2, 3, and 4) were treated conservatively with radiotherapy, two having endocrine treatment in addition. The fifth (Case 5) had the affected eye enucleated because of secondary glaucoma before the diagnosis was made. This was the only case with extraocular extension of the tumour and she subsequently received radiotherapy to the orbit.Only the two enucleated eyes already mentioned (Cases 5 and 6) had histological confirmation of the diagnosis. The four clinically diagnosed patients had flattish grey ill-defined choroidal lesions associated with shallow retinal detachments. They all had proven histories of breast carcinoma. Hogan (I964), discussing the differential diagnosis of metastatic intraocular tumours, stated that the principal method of establishing the diagnosis was based on observation of a primary tumour elsewhere in the body. These four patients (Cases I, 2, 3, and 4) had good functional results with conservative therapy and two of them (Cases i and 2) had deposits in both eyes. Of the six affected eyes in these four patients, one deteriorated, two remained unchanged, and three improved after therapy (Table II).
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