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Improved diagnostic and therapeutic methods, widespread use of photocoagulation in vascular disorders and vitreoretinal surgery in traumas, effective antimicrobial treatment, increasing use of corticosteroids and immunosuppressants, have contributed to the decreasing frequency of enucleation. Tumor patients generally presented late with advanced tumors totally filling the eye, not salvageable by other non-invasive treatment methods. Prompt diagnosis of intraocular malignant tumors (retinoblastoma and malignant melanoma) may reduce the need for enucleation.

The purpose of this study was to review our clinical experience with 132 idiopathic orbital inflammation cases seen between 1971 and 1994. Clinical charts of the patients were evaluated retrospectively. Patient age ranged from 5 to 80 (mean 46.5) years. The follow-up period was between 6 to 172 (mean 42.8) months. Proptosis (82%), motility restriction (54%), visual acuity loss (38%) were the three more common presenting signs. The diagnosis was made by open biopsy in 96 cases and clinically in 36 cases. Radiologic patterns of involvement were available for 84 cases. Diffuse inflammatory disease (40 cases) was the most frequent radiologic pattern followed by myositis (21 cases) and dacryoadenitis (14 cases). Focal encapsulated mass (5 cases), Tolosa-Hunt syndrome (2 cases) perineuritis (1 case) and periscleritis (1 case) were the other types of orbital pseudotumors. The response to treatment was known for 60 of the 84 radiologically classified cases. High-dose oral corticosteroid treatment was successful in 35 out of 60 (58.3%) cases and radiotherapy in 9 out of 14 (64.3%) cases resistant to corticosteroids. One resistant case responded to cyclophosphamide and 2 cases with focal mass lesions were treated with orbitotomy. Four additional cases had spontaneous remission. Overall, 51 out of 64 patients (79.7%) had an eventual good outcome. In conclusion, we found open biopsy to be a safe and reliable procedure in orbital pseudotumors with the exclusion of acute phase cases. The success rate of treatment for this group of orbital disorders is high with the exception of certain disease patterns.

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Purpose: To report the ultrasound biomicroscopy (UBM) findings of anterior segment tumors and simulating conditions. Methods: Thirty-five patients underwent UBM. Of those, 16 had histopathologically or cytopathologically diagnosed tumors, and 19 had clinically diagnosed lesions. Results: The study material comprised 13 iris pigment epithelial (IPE) cysts, 7 ciliary body melanomas, 4 iris melanomas, 4 iris nevi, 3 intraocular invasions of conjunctival squamous cell carcinoma, 2 ring melanomas of the anterior chamber angle, 1 medulloepithelioma and 1 pars plana cyst. On UBM, all IPE cysts presented as cystic lesions with a thin cyst wall and no solid components. All ciliary body melanomas showed low to medium reflectivity, with cavitation in one case and extraocular extension in another. Iris melanomas presented as anterior (stromal) iris lesions with medium to high internal reflectivity. There was irregularity and convex bowing of the posterior iris plane in iris melanomas, a feature not seen in iris nevi. Intraocular invasion of conjunctival squamous cell carcinoma was evidenced as areas of medium to high reflectivity in the ciliary body and iris, loss of the acute angle shape and highly reflective spots in the anterior chamber. Conclusions: UBM was particularly useful in the diagnosis of IPE cysts, in the visualization of small ciliary body melanomas, in the differentiation of iris melanomas from iris nevi and in the demonstration of intraocular invasion from conjunctival squamous cell carcinoma.

The authors reviewed their experience with 429 cases of orbital exenteration between 1963 and 1993. Apart from the 22 cases operated in concert with other physicians, 407 cases were operated by an ophthalmologist and spontaneous granulation technique was used. Total or eyelid-sacrificing exenteration was carried out for lesions involving the eyelids and for recurrent/infiltrative malignant tumors. Two hundred and thirty-seven cases received total exenteration. The remaining 192 cases were treated with eyelid-sparing or subtotal exenteration. In each case, full exenteration was performed with the removal of the periosteum. Secondary tumors were the most frequent indication for exenterations accounting for 349 (81.3%) cases. Among the secondary tumors, there were 173 eyelid, 104 intraocular, 56 conjunctival tumors, 15 nasopharynx and one maxillary sinus carcinomas. The second leading indication was primary orbital tumors (50 cases, 11.7%). Of the primary orbital tumors, 35 were rhabdomyosarcomas, nine were neurogenic tumors, two were fibrocytic tumors, two were vascular tumors, one was teratoma and one was primary melanocytic tumor. The remaining cases included 16 lacrimal fossa tumors (3.7%), 10 lymphomas (2.3%) and four (1.0%) inflammatory pseudotumors. Squamous cell carcinoma was the single most frequent indication for which exenteration was carried out, accounting for 30.3% of the cases. Spontaneous granulation proved to be a simple technique and produces cosmetically better results for patients not wearing prosthesis.