Neoplastic disorders of visual apparatus in clinical optometry: advances and management

Abstract

Ocular neoplasms, both primary and metastatic, may present with visual disturbance or vision loss and often are asymptomatic. Clinical examination may demonstrate leukocoria, abnormal pupillary light reflex, or a mass lesion with or without retinal detachment or hemorrhage. Retinoblastoma in children and uveal melanoma and ocular metastases in adults are the most important ocular malignant neoplasms referred for imaging to aid with diagnosis and staging. Familiarity with their common imaging appearances, the common patterns of spread, and the diagnostic findings of greatest concern to the optometrist or ocular oncologist will enhance accuracy of imaging interpretation. Clinical examination and imaging using B-scan ultrasound, A-scan ultrasound, fluorescein angiography, computed tomography and magnetic resonance imaging have complementary roles in ocular tumor staging and treatment assessment. Ocular neoplasm tumors are relatively rare but require unique diagnostic and treatment considerations given the functional importance of the eye and periocular structures and their unique metastatic behavior. In the following paper, a major malignant tumor of the ocular adnexa including the eyelid, conjunctiva and orbit will be reviewed. Frozen section control of the margins and, in selected cases, Mohs microsurgery have decreased the recurrence rate in malignant eyelid tumors. Intraoperative cryotherapy and postoperative topical mitomycin C have similarly contributed to better surgical outcomes in conjunctival malignant tumors including squamous cell carcinoma and malignant melanoma. Immunotherapy with CD20 antibodies is a developing treatment in Ocular neoplasm lymphomas. Optometrists by the new advances in clinical optometry research, and specialists in occuloplasty / ocularistry form part of the team for a multidisciplinary approach in the clinical management of neoplastic disorders of visual apparatus.