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Orbital tumors refer to benign or malignant neoplasms arising from or extending into the bony orbit and its contents, including the globe, extraocular muscles, nerves, vessels, lacrimal gland, fat, or bone. They may be primary, secondary (extension from adjacent structures), or metastatic.
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| Compartment | Common Tumors |
|---|---|
| Intraconal (within muscle cone) | ‣ ,‣, ‣ |
| Extraconal (outside muscle cone) | Dermoid cyst, ‣, ‣ |
| Intracanalicular/optic nerve sheath | ‣ |
| Bone | ‣ , metastases, ‣ |
| Globe (intraocular tumors) | ‣ , ‣ , uveal metastases |
Soft-tissue orbital compartments on CT and MRI: a Axial and (b) coronal NCCT images in a normal 7-year-old male illustrating the location and appearance of the soft-tissue orbital compartments. c Axial and (d) coronal T2-weighted MR images in a normal 5-year-old male illustrating the location and appearance of the soft-tissue orbital compartments. The soft-tissue orbital compartments shown include the ocular space (O, contains the globe), optic nerve-sheath complex (ONS, contains the optic nerve, nerve sheath, cerebrospinal fluid, ophthalmic artery, central retinal artery and vein), intraconal space (IS, contains orbital fat, ophthalmic artery, cranial nerves 2, 3, 4, and V1), myofascial cone (MC, contains extraocular muscles, cranial nerve 6), and extraconal space (ES, contains fat, lacrimal gland and sac, superior ophthalmic vein, cranial nerve V1—lacrimal and frontal nerves)
Gerrie, S.K., Rajani, H., Navarro, O.M. et al. Pediatric orbital lesions: non-neoplastic extraocular soft-tissue lesions. Pediatr Radiol 54, 910–921 (2024). https://doi.org/10.1007/s00247-024-05892-x
Children:
| Tumor | Notes |
|---|---|
| Capillary hemangioma | Most common benign orbital tumor in infants |
| Rhabdomyosarcoma | Most common malignant orbital tumor in children |
| Lymphangioma | Venolymphatic malformation; may hemorrhage acutely |
| Optic nerve glioma | Often associated with NF1 |
| Neuroblastoma metastasis | Common in younger children; “raccoon eyes” |
| Leukemia | Orbital involvement as chloroma |
Adults:
| Tumor | Notes |
|---|---|
| Lymphoma (MALT) | Most common orbital tumor in adults |
| Cavernous hemangioma | Most common benign adult orbital tumor |
| Meningioma | Arises from optic nerve sheath |
| Metastasis | Breast, prostate, lung, kidney common sources |
| ‣ | Pleomorphic adenoma, adenoid cystic carcinoma |
| Symptom | Description |
|---|---|
| Proptosis | Axial or non-axial, painless (commonly) or painful (if aggressive or inflamed) |
| Globe displacement | Depending on tumor location (e.g., inferomedial with lacrimal gland mass) |
| Diplopia | From mass effect or extraocular muscle involvement |
| Vision loss | If optic nerve compressed or infiltrated |
| Pain | Usually absent unless inflammatory or aggressive lesion |
| Lid swelling / palpable mass | Common with superficial lesions |
| Modality | Utility |
|---|---|
| CT | • Bone detail: Excellent; detects bony remodeling or destruction |
| • Calcification: Common in optic nerve sheath meningioma, retinoblastoma | |
| • Density of mass: Cystic, solid, or fat-containing components | |
| MR | • T1: Defines anatomy; fat is hyperintense |
| • T2: Fluid-sensitive; cystic or vascular tumors are hyperintense | |
| • Post-contrast T1FS: Identifies enhancement patterns (e.g., homogenous in lymphoma) | |
| • DWI/ADC: Restricted diffusion suggests high cellularity (e.g., lymphoma, metastasis) |