Cavernous Hemangioma of the Orbit

Computed tomography (CT) shows that the left eye is pushed forward by the egg-shaped choroidal hemangioma. The posterior eye-wall appears flattened.

Hemangioma is a benign tumor that is found to grow within the orbit. Most commonly found right behind the eye (in the muscle cone), it can push the eye forward causing a bulging doctors call proptosis.

Computed tomography (CT) - Coronal Section demonstrates displacement of the optic nerve (medially) by the choroidal hemangioma.

Symptoms
Cavernous hemangioma of the orbit is most commonly seen in middle-aged women. Most are found within the muscle cone, but can be found anywhere in the orbit.

Computed tomography (CT) - Coronal Section demonstrates displacement of the optic nerve (medially) by the choroidal hemangioma.

If large, they can indent the back of the eye causing choroidal folds, or push on the optic nerve causing atrophy.

A fundus photograph demonstrates choroidal folds induced by the choroidal hemangioma indenting the posterior eye-wall.

Rarely, the eye can become pushed out (proptotic) so far that there are corneal exposure problems (keratitis, spk, ulceration).

Diagnosis
Cavernous hemangioma of the orbit is usually a slow-growing tumor. If the tumor has not damaged the eye, cavernous hemangioma can be observed for growth prior to considering intervention. Should tumor growth occur, it will be measured by eye examinations including (but not limited to) visual acuity, color vision assessment, Hertel exophthalmometry (a measure for proptosis), as well as an evaluation for double vision (strabismus), corneal exposure, retinopathy, vascular damage, and optic neuropathy.

Treatments
Treatment of orbital hemangioma is indicated when there is evidence of growth, optic nerve compression, and corneal exposure (with secondary keratitis sicca), or evidence of vision loss.

The goal of local resection for choroidal hemangioma should be complete removal of the tumor. This usually involves careful dissection of the tumor to protect the tumor's capsule (as possible). Connecting vascular feeder vessels should be identified and cauterized. A lateral orbitotomy is usually required to keep the large tumor intact.

Additional Info
Histopathology of cavernous hemangioma will demonstrate dilated vascular channels, lined by benign cells.

Histopathologic sections with elastin-stain also demonstrate the large loosely distributed vascular channels associated with orbital hemangioma. The tumor's capsule is noted on the right.

Read about the use of Finger-tip cryoprobes to aid extraction of orbital hemangioma in the innovations section.

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