Lacrimal gland carcinoma Biopsy Painful, fast-growing mass in lacrimal fossa Infero-nasal globe displacement Posterior extension may cause proptosis, ophthalmoplegia and episcleral congestion Trigeminal hypoaesthesia in 25%Management Radical surgery and radiotherapy Presents - 4th to 6th decades Very poor prognosis

Lacrimal gland carcinoma Biopsy Painful, fast-growing mass in lacrimal fossa Infero-nasal globe displacement Posterior extension may cause proptosis, ophthalmoplegia and episcleral congestion Trigeminal hypoaesthesia in 25%Management Radical surgery and radiotherapy Presents - 4th to 6th decades Very poor prognosis

Optic nerve sheath meningioma Typically affects middle-aged womenOptociliary shunts in 30% Proptosis due to intraconal spread Thickening and calcification on CTGradual visual loss due to optic nervecompressionTreatment Observation - slow-growing tumours Excision - aggressive tumours and poor vision Radiotherapy - slow-growing tumours and good vision

LymphomaPresents - 6th to 8th decadesAffects any part of orbit and may be bilateralAnterior lesions are rubbery on palpitationTreatmentMay be confined to lacrimal glands Radiotherapy - localized lesions Chemotherapy - disseminated disease

RhabdomyosarcomaMay involve any part of orbit Most common primary childhood orbital malignancyPalpable mass and ptosis in about 30% Rapid onset in first decade ( average 7 yrs )Treatment Radiotherapy and chemotherapy Exenteration for radio-resistant or recurrent tumours

Adult metastatic tumoursSimilar to orbital pseudo-tumour

Common primary sites - breast, bronchus, prostate, skin melanoma, gastrointestinal tract and kidneyCranial nerve involvement at orbital apex and mild proptosisPresentationsAnterior orbital mass with non-axial globe displacementEnophthalmos with schirroustumours

Childhood metastatic tumours Presents in early childhoodNeuroblastoma May be bilateral Typically involves superior orbitChloroma Presents at about age 7yrs Rapid onset proptosis - may be bilateral Subsequent systematic dissemination to full-blown leukaemia

Kelopak mataJinak nervus, veruca, xanthelasma, hemangiomaGanas basalioma, squamous cell carcinoma, adeno carcinoma, melanoma maligna

KonjungtivaJinak nervus, papiloma, granuloma, fibroma, limfomaGanas epidermoid ca, melanoma maligna, limfo sarkoma

Signs of chalazion (meibomian cyst)Painless, roundish, firm lesion within tarsal plateMay rupture through conjunctiva and cause granuloma

Acute hordeola Staph. abscess of meibomian glands Tender swelling within tarsal plate May discharge through skin or conjunctiva Staph. abscess of lash follicle and associated gland of Zeis or Moll Tender swelling at lid margin May discharge through skinInternal hordeolum ( acute chalazion )External hordeolum (stye)

Xanthelasma Usually bilateral and located medially Common in elderly or those with hypercholesterolaemia Yellowish, subcutaneous plaques containing cholesterol and lipid

Translucent On anterior lid marginCyst of Moll Similar to cyst of Moll Not confined to lid marginEyelid cysts Opaque On anterior lid marginCyst of ZeisEccrine sweat gland hidrocystomaSebaceous cyst Cheesy contents Frequently at inner canthus

Viral wart (squamous cell papilloma) Most common benign lid tumour Raspberry-like surfacePedunculatedSessile

Seborrhoeic Common in elderly Discrete, greasy, brown lesion Friable verrucous surface Flat stuck-on appearanceActinic Most common pre-malignant skin lesion Rare on eyelids Affects elderly, fair-skinned individuals Flat, scaly, hyperkeratotic lesionKeratoses

Naevi Appearance and classification determined by location within skin Tend to become more pigmented at puberty ElevatedIntradermal May be non-pigmented No malignant potential Flat, well-circumscribed Low malignant potentialJunctional Has both intradermal and junctional componentsCompound Pigmented

Capillary haemangioma Rare tumour which presents soon after birth Starts as small, red lesion, most frequently on upper lid Blanches with pressure and swells on crying Grows quickly during first year May be associated with intraorbital extension Begins to involute spontaneously during second year

Pyogenic granuloma Usually antedated by surgery or trauma Fast-growing pinkish, pedunculated or sessile mass Bleeds easilyCutaneous horn Uncommon, horn-like lesion protruding through skin May be associated with underlying actinic keratosis or squamous cell carcinoma

Frequency of location of basal cell carcinomaLower lid - 70%Medial canthus - 15%Upper lid - 10%Lateral canthus - 5%

Squamous cell carcinoma Predilection for lower lid Hard, hyperkeratotic nodule Less common but more aggressive than BCC May develop crusting fissures May arise de novo or from actinic keratosisUlcerative No surface vascularization Red base Borders sharply defined, indurated and elevatedNodular

MelanomaFrom lentigo maligna (Hutchinson freckle)Nodular Blue-black nodule with normal surrounding skin Plaque with irregular outline Variable pigmentation Affects elderly Slowly expanding pigmented macule May be non-pigmentedSuperficial spreading

Kaposi sarcomaAdvanced EarlyPink, red-violet lesion Vascular tumour occurring in patients with AIDS Usually associated with advanced disease Very sensitive to radiotherapyMay ulcerate and bleed

Naevus 30% are almost non-pigmented Most frequently juxtalimbal Sharply demarcated and slightly elevated Presents in first two decades

PapillomaPedunculatedSessile Presents in middle age Not caused by infection Single and unilateral Presents in childhood or early adulthood Infection with papilloma virus May be multiple and bilateral

Presents in childhood Smooth, soft mass Usually juxtalimbal Occasionally Goldenhar syndromeEpibulbar dermoidSignsAssociation

Lipodermoid Presents in adulthood Soft, movable, subconjunctival mass Most frequently at outer canthus

Intraepithelial neoplasia(carcinoma in situ) Juxtalimbal fleshy avascular mass May become vascular and extend onto cornea Presents in late adulthood Malignant transformation is uncommonSignsProgression

Conjunctival melanomaFrom PAM with atypia Sudden appearance of nodules in PAMFrom naevus Sudden increase in size or pigmentationPrimary Solitary nodule Frequently juxtalimbal but may be anywhere Very rare Most common type

Squamous cell carcinoma Rarely metastasizes Arises from intraepithelial neoplasia or de novo Frequently juxtalimbal Slow-growing Presents in late adulthood May spread extensivelySignsProgression

Lymphoma Salmon-coloured, subconjunctival infiltrate Usually presents in adulthood Benign or malignant

Retinoblastomaadalah tumor ganas dalam bola mata yang berasal dari jaringan embrional retina

Patologi anatomisel bulat dengan sedikit sitoplasma serta nukleus yang berisi banyak kromatin, berbentuk roset atau pseudo roset

Leukocoria - 60% Strabismus - 20% Secondary glaucoma Anterior segment invasion Orbital inflammation Orbital invasionPresentations of retinoblastoma

Early endophyliticretinoblastomaWhite flat lesionPlacoid lesion

More advanced endophytic retinoblastomaFriable white massCottage cheese appearanceFine surface blood vesselsVitreous seedings

Exophytic retinoblastomaMultiglobulated white mass withoverlying retinal detachmentMay be difficult to visualize through deep detachment

CT diagnosis of retinoblastomaCalcification Optic nerve involvement Orbital and CNS extension Pinealoblastoma

Differential diagnosis of leukocoriaCongenital cataract Unilateral or bilateral UnilateralInflammatory cycliticmembrane Persistent hyperplasticprimary vitreous Unilateral or bilateralCoats disease Unilateral UnilateralAdvanced retinopathy of prematurityPosterior pole toxocaragranuloma Always bilateral but may be asymmetrical

Metastase

Kelenjar perihiler dan kelenjar getah bening yang berdekatanLamina kribrosa ke saraf optik intrakranialKoroid dan secara hematogen menyebar ke seluruh tubuh

Pemeriksaan penunjangX foto kalsifikasiUSG / CT Scan media keruh

DD :KatarakPersistent hyperplastic primary vitreusRetrolental fibroplasiaAblasio retinaUveitisPanoftalmitisPerdarahan vitreusHyaloid kista

Intraokuler dan unilateralPhotocoagulasi (diatermi atau cryoterapi)enukleasiMenyebar ke orbita dan saraf optikEksenterasi orbitaRadiasikemoterapiItraokuler & bilateralSatu mata dienukleasi untuk menentukan diagnosa sedangkan mata yang lain konserfatif sambil menunggu hasil PA

Baik stadium dini (stadium intraokuler)

Buruk tumor bilateral, telah menyebar ke saraf optik dan metastase (stadium ekstraokuler)

Iris melanoma Usually pigmented nodule at least 3 mm in diameter Invariably in inferior half of iris Occasionally non-pigmented Surface vascularization Angle involvement may cause glaucoma Pupillary distortion, ectropion uveae and cataract

Iris naevusTypicalDiffuse Diameter usually less than 3 mm Occasionally mild distortion of pupil and ectropion uvea Obscures iris crypts May cause ipsilateral hyperchromic heterochromia May be associated with Cogan-Reese syndrome Pigmented, flat or slightly elevated

Choroidal melanoma (1) Brown, elevated, subretinal mass Occasionally amelanotic Double circulation Secondary retinal detachment Choroidal folds