Chapters are well laid out and organised in a clear and logical manner. Betrokkenen Redacteur W.
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Liefhebbers van Springer bekeken ook. In patients with highly asymmetric glaucoma or eye pressure elevation that is resistant to standard medical therapy a thorough history and ocular exam including pertinent imaging should be performed to rule out intraocular malignancies. Tumors within the globe can lead to elevation in intraocular pressure IOP and permanent damage to the ocular structures.
In patients who present with atypical, unilateral or highly asymmetric glaucoma, suspicion for intraocular malignancies must be high. The pressure can be further increased depending on the amount of inflammation, necrosis or hemorrhage present. Most systemic tumors affect the choroid with breast, lung and kidney being the most common primary sites. In tumors located in the anterior segment of the eye the most common mechanism for secondary intraocular pressure elevation is direct invasion of the tumor cells into the anterior chamber angle.
This mechanically blocks aqueous humor from leaving the eye, which directly causes a rise in pressure within the globe.
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This can been seen clinically on gonioscopy as well as at the cellular and molecular level using immunohistochemistry ICH and electron microscopy EM of tissue specimens. For all anteriorly located metastatic tumors and iris melanomas, mechanical obstruction is the most common cause of secondary glaucoma. Massive dispersion of pigment displaced from tumor cells i. Melanomalytic glaucoma is secondary to the release of pigment from tumor cells which subsequently get taken up by macrophages.
A sheet-like plaque of malignant tumor cells that spread over an open anterior chamber angle can cause mechanical obstruction if enough of the trabecular meshwork is blocked.
This causes a secondary elevation of pressure within the eye and secondary glaucoma. Aqueous humor outflow is dependent on the pressure gradient between intraocular pressure and episcleral venous pressure. Orbital tumors or extraocular extension of an intraocular tumor can cause an increase in episcleral venous pressure through direct compression.
Inflammation secondary to intraocular tumors can cause peripheral anterior synechiae, which can lead to closure of the angle and elevation in intraocular pressure. In patients with uveal melanomas and uveitis, secondary angle closure is common from peripheral anterior synechiae. Patients with intraocular tumors can often develop neovascularization of the iris and angle, which can lead to angle closure glaucoma.
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This is commonly true in tumors which cause a chronic retinal detachment especially choroidal melanomas leading to ischemia of the tissue and resultant secondary neovascularization. The most common mechanism of angle closure in patients with intraocular tumor is forward displacement of the lens-iris diaphragm. The workup begins with a thorough history, which should be performed in all patients with elevated intraocular pressure from atypical cases of glaucoma. A thorough history includes all of the following:. The symptoms that the patient experience depend greatly on the type and location of the malignancy as well as the amount of ocular involvement.
The most frequently recorded symptoms are blurred vision, pain, redness and floaters.
What Are Orbital and Ocular Tumors?
Extraocular and slit lamp biomicroscopy exams of the anterior and posterior segments of each eye should be performed as well as a thorough gonioscopy of the angle. A complete dilated exam should be performed in all patients, as long as the anterior chamber angle is not too narrow. The following findings are essential to note for any patient suspected of having tumor induced secondary glaucoma. Specifically, it is helpful in taking measurements of the posterior segment tumors like uveal melanomas and looking for concurrent retinal detachments, vitreous hemorrhage or vitritis.
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To further characterize tumors in the anterior segment, ultrasound biomicroscopy can be performed. UBM uses a high frequency wavelength which allows for accurate measurements of anterior lesions which is helpful for diagnosis solid versus cystic masses and follow up.
If there is still uncertainty with the diagnosis after a full history, physical exam and imaging then diagnostic sampling of the lesion can be performed for most tumors it is contraindicated in retinoblastoma. Involvement of the eye can occur in just under one-third of cases of systemic leukemia. On posterior segment exam vitritis and subretinal infiltrates may be present. Symptoms usually include pain, blurred vision and eye redness.
[Radiotherapy of eye and orbit tumors].
Lymphoma with metastasis to the eye tends to occur at a lower rate compared to leukemia. Secondary elevation of intraocular pressure more commonly occurs from tumor seeding of the trabecular meshwork, but angle closure and iris neovascularization has also been reported. The most common type of intraocular tumor is metastases. These tumors most frequently are located in the uveal tract, with the most common primary sites being breast and lung.
Secondary intraocular pressure elevations is much more common in anteriorly located metastatic tumors.
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The most common primary intraocular malignancy in adults is uveal melanoma with the majority located within the choroid. Open angle glaucoma in uveal melanoma patients can occur due to tumor seeding of the anterior chamber angle, direct invasion of the tumor into the angle and melanomalytic obstruction.