OCULAR SWELLINGS/TUMORS DR OKOH - PowerPoint Presentation

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OCULAR SWELLINGS/TUMORS

DR OKOH

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Eyelid swellings

Localized swelling of the eyelids around the eyes

Inflammation/infectious

Tumour

-swelling without inflammation

Benign: slow growing, do not invade surrounding tissues, do not spread and their outcome usually good

Malignant-rapidly growing, invade and spread to tissues nearby and far, and usually the outcome may not be

favourable

(cancerous)

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Lumps

Cyst and Abscesses- usually caused by

infection-staphylococcal

Duct/gland blockage

Poor hygiene

Dirty contact lens

Cosmetics

Leaving make up late at night

Touching and rubbing eye with unclean hand

Benign and premalignant

Malignant

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External

Hordeolum

(

stye

)

Abscess in the lash follicle

Painful and tender

Staphylococcal in origin

Treatment use of warm compress, removal of the lash and drainage of the abscess by compressOral antibiotic, usually if associated with preseptal cellulitis

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Internal Hordeolum

Abscess within the

Meibomian

Gland

Tender and painful

Staphylococcal in origin

Treatment, warm compress, in large cases incision and drainage, oral antibiotic

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Hidrocystoma, cyst of Moll

Blockage of apocrine duct

Chronic

Translucent

Recur with I/D

Total excision and

deroofing

to the base with diathermy

Laser and Botox

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Hidrocystoma

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Cyst of Zeis

Chronic

Transluscent

Similar to sebaceous cyst

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Sebaceous cyst

Rare in the lids

Commoner in hairy part of the body

Treatment is by I/D but usually recur

Complete treatment is by excision

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Xanthelasma

Lipid deposit

Medial aspect and

periorbit

Sign of

hyperlidipaemia

Treatment is superficial excision, CO2 laser ablation,

trichloroacetic

acid

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Milia

Smaller epidermal inclusion cyst of hair follicles

Occur in infant, consider as primary and almost normal

Secondary, eruptive and

milia

en plaque is common in woman

Arise from skin diseases, trauma, drug cream, tattoos

Treatment is topical

tretinin,oral etrenitate, monocyclineLaser

Excision

cryotherapy

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Molluscum

Contagiosum

Common in children

In adult, especially immunosuppression(HIV/AIDS)

DNA pox virus

Transmission via close contact

Treatment –

podophyllin,silver

nitrate,cryotherapy,cauterization,expression/curettage

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Wart

Caused by HPV

Contagious

Seen in all age,

More common in immunosuppressed

Treatment, self limiting

Medical-salicylate patch,

imiquimod,podophyllin

, intralesional cidofovir, oral zinc sulfateSurgery-excision, laser, cryotherapy,electrodesication

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Chalazion

Commonest lid lump

Chronic

lipogranuloma

inflammation of blocked MG

Usually more in upper lid

Commoner in

pts

with blepharitis/dermatitisSmall resolve, hot compress, I/C

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Benign lump

Papillomas

Common

Squamous in origin

May non specific and may related to HPV

Sessile or

pedunclated

Treatment is by excision

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Naevus

Arrested epidermal melanocytes

Low risk of transformation

Treatment is usually by excisional biopsy

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Dermoid cyst

Congenital

choristoma

Smooth, firm, non tender and slowly growing in children

Require radiological investigation

It may extend to frontal sinus, temporal fossa or cranium

Treatment is excision without rupture

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Capillary Haemangioma

Children

Involute at about 5years

Amblogenic

Treatment option are excision,

intralesional

steriod

, oral propranolol

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Neurofibroma

Uncommon, poorly define

tumour

of peripheral nerve

Strongly associated with neurofibromatosis 1

Call bag of worms mass

S shape lid deformity

Treatment is surgical excision, difficult, repeated

debulking usually required

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Pyogenic granuloma

Abnormal response to injury/inflammation

Highly vascular with granulation tissue

Treatment is excision

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Malignant Lump

Basal cell carcinoma

Squamous cell carcinoma

Sebaceous gland carcinoma

Malignant Melanoma

Kaposi sarcoma

Merkel cell carcinoma

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BCC

Commonest lid malignancy

Lower lid –medial canthus-upper lid-lateral canthus

Locally invasive but rarely metastasize

Risk factor,

inceasing

age,white

skin, sun exposure,skin disease,albinism

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Types

Nodular or Rodent ulcer firm nodule with surface ulceration

Morpheiform

(

sclerosing

)-scar like plaque with minimal surface changes

superficial –reddish, scaly resembles fungal infection

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Treatment

For small BCC 5%

imiquimod

cream usually applied 5x/week for 6-12month

Cryotheraphy

for low risk BCC like small nodular

Excision wide margin excisional biopsy(

Mohs

micrographic technique)

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BCC

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SCC

Less common(2-5%)

Higher rate of

metatastasis

Lower lid more affected

Risk factor-increasing

age,sun

exposure,white skin,albinism,x-ray exposure,chemical exposure,immunosuppression and skin disease like xeroderma pigmentosa

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Types

Nodular like BCC

Plaque –erythematous and scaly

Mixed

Cutaneous horn-

hyperkeratotic

actinic keratosis or well differentiated SCC

Bowen disease squamous carcinoma in situ

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Treatment

Wide local excision biopsy

Orbital involvement-

exenteration

SCC in situ-cryotheraphy,imiquimod,5FU ,

mitomycin

and PDT

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SCC

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Sebaceous gland carcinoma

Uncommon

Arise from MG and occasionally from

Zeis

High mortality rate

More upper lid

Affect older age female

asian

2types, nodular and spreading types

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Treatment

Mapping biopsy to conjunctiva and regional lymph nodes

Regional lymph node clearance and

exenteration

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Sebaceous CC

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Malignant melanoma

Rare

Most be considered if lesion is pigment-fatal

Non invasive horizontally, vertically invasive

Risk factors-like BCC,SCC

Types

Lentigo

maligna-flat,pigmented,well define margin which elevates as sign of malignant transformation

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MM

Superficial spreading-irregular margin with mild elevation with or without nodule-aggressive

Nodular types-

nodules,may

not be

pigmented,rapid

growth, ulcerative and bleeds

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Treatment

Wide margin excision-10mm margin recommended

Dissection of regional lymph node

recommemded

if

tumour

is > 1.5mm

Prognosis-5yrs survival rate is 100% if

tumour is < 0.75mm in thickness,50% if >1.5mm

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MM

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Kaposi’s Sarcoma

Rare

Cause HHV8

Common in AIDS

pts

Vascular and may affect the conjunctiva

Treatment is

radiotheraphy

Not curative

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Conjunctiva swellings

Benign

Papilloma 2 types,

pedunculated,young

and sessile middle age, associated with HPV

Treatment-spontaneous resolution, oral cimetidine,

MMC,cryotherapy

,

interferon,surgery

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Dermoid cyst

Uncommon

choristoma

Limbal

mass

Unilateral

Treatment- CT to exclude

intraorbital

/intracranial extension, excision

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Malignant conjunctiva tumor

SCC

Commonest malignant conjunctiva tumor

More 50years, younger with HIV

Related to HPV and UV light

Persistent unilateral

keratoconjunctivitis

Treatment-

excision,MMC,cryotherapy,enucleation/extenteration

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Conjunctiva kaposi

sarcoma

Bright red mass

Inferior fornix

Mimic

conjunctival

subconjunctival

haemorrhageCaused by HHV8 in the presence of HIVTreatment-focal radiotherapy

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Pterygium/

Pinguecula

-triangular

fibrovascular

-

interpalpebral

-risk factor are dry climate, UV

-elastotic degeneration-cosmesis issue,FB

sensation

-treatment-excision with

autograft,MMC

5FU

-recurrence is common

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Vascular tumours

Cavernous

haemangioma-harmatoma,commonest

benign

tumour

in adult,

intraconal

, increase in pregnancy and appear in early adulthood

Causes proptosis, usually observed but is excised if symptomaticOrbital tumour

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Capillary

haemagioma-harmatoma

, may be consumptive and can cause cardiac failure, usually seen before 2mths,disappear by 6yrs

Treatment

steriod

, topical

intalesion

, systemic steroid,

propanalol and surgical excisionOrbital varices-uncommon,congenital, unilateral and usually medial orbitCause intermittent proptosis, treatment is surgical excision, sclerosant

injection

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Commonest

pri

orbital malignancy of childhood

M:F 1.6:1

Seen before 15yrs, peak years 5-7.5years

Cause rapid

proptosis

, mimic inflammatory condition

Investigation include USS, CT, MRITreatment is excision, radiotherapy, chemotherapy, combineRhabdomyosarcoma

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Pleomorphic adenoma-commonest lacrimal

tumour,seen

in middle

age,commoner

in male

Cause painless

proptosis

and dystopia

May undergo malignant transformationTreatment is by excisionLacrimal carcinomas-adenoid cystic ca,mucoepidermoid ca, pleomorphic adenocarcinoma-treatment is extenteration±radiotheraphyLacrimal gland

tumour

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Optic nerve glioma

-rare

tumour

of glial tissue, common in children, strong association with neurofibromatosis-1

Causes axial

proptosis

and vision loss

Treatment is by excision and

radiotheraphyOptic nerve meningiomas-middle age female, observe in good vision or exciseNeural tumour

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Retinoblastoma-commonest intraocular malignant

tumour

in adult

1:15000

lifebirth

Present between 1-2years, before 6years

Arise from primitive

retinoblast

90% sporadic,10% inherited, 90% penetrancePresent with leukocoria, strabismus,acute red eye, orbital inflammationIntraocular tumour

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Investigation is by USS, CT, MRI

Treatment is

multidisplinary

Aim is life/globe/vision

Option of treatment are photocoagulation,

cryotherapy

, radiotherapy,

chemotherapy,enucleation

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Rule of the thumb

If in doubt do a biopsy

The only sure test for diagnosis

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t

hank You for Listening