their use in compressive spinal cord lesions; as an analogy, similarly they are not recommended for prostatic metastases located in the orbital apex [14, 20, 74, 113].

12.11.4Surgery

Except for exceptional cases of carcinoid and renal cell tumors, surgery is mainly used for diagnostic, rather than therapeutic, purposes since the disease is usually already widespread [39, 59, 75, 111]. Surgery may also have a palliative benefit in those cases in which other treatments have failed.

References 181

survival rate of up to 35%, and cures have been reported [96, 144]. Cutaneous melanoma can have a long latency, up to 46 years [115]. However, once the orbit is involved, the disease progresses rapidly, with a very short life expectancy [53]. Lung cancer has usually a fulminant course, and the survival is commonly less than 6 months [53].

In our series of 80 cases, melanoma also tended to present in a younger age group (mean 54 years) when compared with breast cancer (mean 62 years), carcinoid tumor (mean 63 years), and prostate cancer (mean 70 years) (p < .005) [150].

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12.12 Prognosis and Survival

The overall survival of patients with orbital metastases is generally limited to less than a year [39, 45, 53, 64, 126]. A specific prognosis is di cult to obtain given the diversity of primary malignancies. In general, the outcome is poor, although multidisciplinary therapy can be palliative, sometimes inducing remissions and even obtaining cures in some exceptional cases [3].

Metastatic breast carcinoma and carcinoid tumors are typically diagnosed long before the patient consults an ophthalmologist, and survival is often measured in years [54]. Thyroid carcinoma also has a longer survival, but its initial diagnosis can be challenging [64,68].Isolated cases of metastatic renal cell carcinoma managed surgically have a 5-year

Summary for the Clinician

■Metastatic orbital disease includes a heterogeneous group of neoplasms with presentation that varies depending on the extent of the disease and the biology of the primary tumor.

■A complete past medical history, a high index of suspicion, and the rapid progression of the symptoms are key in the diagnosis.

■Strabismus, globe displacement, and pain are common features of this entity.

■Investigations include appropriate orbital and systemic imaging, with histologic studies on orbital tissue in most cases.

■A multidisciplinary approach is essential for adequate management in an attempt to preserve vision, relieve pain, and improve the quality of life. Improved survival, and even cure in some cases, may be achieved.

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