- •Preface
- •Contents
- •Contributors
- •1 Primary Orbital Cancers in Adults
- •1.1 Lymphoproliferative Disorders
- •1.1.1 Presenting Signs and Symptoms, Histopathologic and Molecular Genetic Characteristics, and Diagnosis
- •1.1.2 Treatment
- •1.1.3 Follow-up
- •1.2 Mesenchymal Tumors
- •1.2.1 Fibrous Histiocytoma
- •1.2.2 Solitary Fibrous Tumor
- •1.2.3 Hemangiopericytoma
- •1.2.4 Other Mesenchymal Tumors
- •1.3 Lacrimal Gland Tumors
- •References
- •2 Nonmalignant Tumors of the Orbit
- •2.1 Presentation
- •2.2 Cystic Lesions
- •2.3 Vascular Tumors
- •2.4 Lymphoproliferative Masses
- •2.6 Mesenchymal Tumors
- •2.7 Neurogenic Tumors
- •2.8 Lacrimal Gland Tumors
- •References
- •3 Pediatric Orbital Tumors
- •3.1 Introduction
- •3.2 Cystic Lesions
- •3.2.1 Dermoid Cyst
- •3.2.1.1 Clinical Presentation
- •3.2.1.2 Imaging
- •3.2.1.3 Histopathology
- •3.2.1.4 Treatment
- •3.2.1.5 Prognosis
- •3.2.2 Teratoma
- •3.2.2.1 Clinical Presentation
- •3.2.2.2 Imaging
- •3.2.2.3 Histopathology
- •3.2.2.4 Treatment
- •3.2.2.5 Prognosis
- •3.3 Vascular Tumors
- •3.3.1 Capillary Hemangioma
- •3.3.1.1 Clinical Presentation
- •3.3.1.2 Imaging
- •3.3.1.3 Histopathology
- •3.3.1.4 Treatment
- •3.3.1.5 Prognosis
- •3.3.2 Lymphangioma
- •3.3.2.1 Clinical Presentation
- •3.3.2.2 Imaging
- •3.3.2.3 Histopathology
- •3.3.2.4 Treatment
- •3.3.2.5 Prognosis
- •3.4 Histiocytic Lesions
- •3.4.1 Eosinophilic Granuloma
- •3.4.1.1 Clinical Presentation
- •3.4.1.2 Imaging
- •3.4.1.3 Histopathology
- •3.4.1.4 Treatment
- •3.4.1.5 Prognosis
- •3.5 Neural Tumors
- •3.5.1 Optic Nerve Glioma
- •3.5.1.1 Clinical Presentation
- •3.5.1.2 Imaging
- •3.5.1.3 Histopathology
- •3.5.1.4 Treatment
- •3.5.1.5 Prognosis
- •3.5.2.1 Clinical Presentation
- •3.5.2.2 Imaging
- •3.5.2.3 Histopathology
- •3.5.2.4 Treatment
- •3.5.2.5 Prognosis
- •3.6 Malignant Lesions
- •3.6.1 Ewing Sarcoma
- •3.6.1.1 Clinical Presentation
- •3.6.1.2 Imaging
- •3.6.1.3 Histopathology
- •3.6.1.4 Treatment
- •3.6.1.5 Prognosis
- •3.6.2 Neuroblastoma
- •3.6.2.1 Clinical Presentation
- •3.6.2.2 Imaging
- •3.6.2.3 Histopathology
- •3.6.2.4 Treatment
- •3.6.2.5 Prognosis
- •3.6.3 Retinoblastoma
- •3.6.3.1 Clinical Presentation
- •3.6.3.2 Imaging
- •3.6.3.3 Histopathology
- •3.6.3.4 Treatment
- •3.6.3.5 Prognosis
- •3.6.4 Granulocytic Sarcoma
- •3.6.4.1 Clinical Presentation
- •3.6.4.2 Imaging
- •3.6.4.3 Histopathology
- •3.6.4.4 Treatment
- •3.6.4.5 Prognosis
- •3.6.5 Rhabdomyosarcoma
- •References
- •4.1 Introduction
- •4.2 Clinical and Radiological Presentation
- •4.3 Staging
- •4.4 Surgery
- •4.5 Chemotherapy
- •4.6 Radiation Therapy
- •4.7 Conclusions and Future Directions
- •References
- •5 Metastatic Orbital Tumors
- •5.1 Introduction
- •5.2 Incidence
- •5.3 Anatomical Considerations
- •5.4 Presentation and Clinical Features
- •5.5 Diagnosis
- •5.6 Treatment
- •5.7 Types of Cancer Metastatic to the Orbit
- •5.7.1 Breast Carcinoma
- •5.7.2 Lung Carcinoma
- •5.7.3 Prostate Carcinoma
- •5.7.4 Melanoma
- •5.7.5 Carcinoid Tumors
- •5.7.6 Other Cancers
- •5.8 Conclusion
- •References
- •6.1 Tumors of Intraocular and Ocular Adnexal Origin
- •6.1.1 Eyelid Tumors
- •6.1.2 Intraocular Tumors
- •6.2 Tumors of Sinus and Nasopharyngeal Origin
- •6.2.1 Squamous Cell Carcinoma
- •6.2.2 Other Tumors of Sinus and Nasopharyngeal Origin
- •6.3 Tumors of Brain Origin
- •6.3.1 Meningioma
- •6.3.2 Other Intracranial Tumors
- •References
- •7 Lacrimal Gland Tumors
- •7.1 Introduction
- •7.2 Lymphoproliferative Lesions of the Lacrimal Gland
- •7.3 Benign Epithelial Tumors of the Lacrimal Gland
- •7.3.1 Pleomorphic Adenoma
- •7.3.2 Other Benign Epithelial Tumors
- •7.4 Malignant Epithelial Tumors of the Lacrimal Gland
- •7.4.1 Adenoid Cystic Carcinoma
- •7.4.2 Other Malignant Epithelial Tumors
- •7.5 AJCC Staging for Lacrimal Gland Tumors
- •References
- •8.1 Introduction
- •8.2 Indications
- •8.3 Surgical Techniques
- •8.3.1 Medial Orbitotomy Approach
- •8.3.2 Medial Eyelid Crease Approach
- •8.3.3 Lateral Orbitotomy Approach
- •8.3.4 Lateral Canthotomy Approach
- •8.4 Possible Indications for ONSF in Cancer Patients
- •8.4.1 Metastatic Breast Cancer
- •8.4.2 Lymphomatous Optic Neuropathy Diagnosed by Optic Nerve Biopsy
- •8.4.3 Adjuvant Therapy in Optic Nerve Sheath Meningioma
- •8.4.4 Papilledema Associated with Brain Tumors
- •8.4.5 Radiation-Induced Optic Neuropathy
- •8.5 Complications of ONSF
- •8.6 Future Research
- •References
- •9 Management of Primary Eyelid Cancers
- •9.1 Introduction
- •9.2 Types of Eyelid Malignancies
- •9.2.1 Basal Cell Carcinoma
- •9.2.2 Squamous Cell Carcinoma
- •9.2.3 Melanoma
- •9.2.4 Sebaceous Gland Carcinoma
- •9.2.5 Other Primary Eyelid Malignancies
- •9.3 Management
- •9.3.1 Evaluation
- •9.3.2 Tumor Excision and Eyelid Reconstruction
- •9.3.3 Sentinel Lymph Node Biopsy
- •9.3.4 Nonsurgical Treatment
- •9.3.5 Follow-up
- •References
- •10 Management of Conjunctival Neoplasms
- •10.1 Introduction
- •10.2 Squamous Cell Neoplasms of the Conjunctiva
- •10.2.1 Conjunctival Intraepithelial Neoplasia
- •10.2.2 Invasive Squamous Cell Carcinoma
- •10.2.3 Management
- •10.2.3.1 Local Excision and Cryotherapy
- •10.2.3.2 Treatment of More Advanced Disease
- •10.2.4 Surveillance
- •10.3 Melanocytic Neoplasms
- •10.3.1 Nevus
- •10.3.2 Primary Acquired Melanosis
- •10.3.3 Conjunctival Melanoma
- •References
- •11 Surgical Specimen Handling for Conjunctival and Eyelid Tumors
- •11.1 Introduction
- •11.2 Communication with the Pathologist
- •11.3 Conjunctival Specimens
- •11.4 Eyelid Specimens
- •11.5 Mohs Micrographic Surgery
- •11.6 Summary
- •References
- •12 Neuroradiology of Ocular and Orbital Tumors
- •12.1 Introduction: Imaging and Protocol
- •12.2 Anatomy
- •12.3 Intraocular Lesions
- •12.3.1 Retinoblastoma
- •12.3.2 Uveal Melanoma
- •12.3.3 Uveal Metastases
- •12.4 Orbital Lesions
- •12.4.1 Lymphoma
- •12.4.2 Orbital Rhabdomyosarcoma
- •12.4.3 Orbital Nerve Sheath Tumors
- •12.4.4 Mesenchymal Tumors of the Orbit
- •12.4.5 Orbital Pseudotumor
- •12.4.6 Orbital Metastases
- •12.5 Optic Nerve Tumors
- •12.5.1 Optic Nerve Glioma
- •12.5.2 Optic Nerve Sheath Meningiomas
- •12.6 Lacrimal Gland Tumors
- •12.7 Secondary Tumor Spread to the Orbit
- •12.8 Periorbital Skin Cancer and Perineural Spread
- •12.9 Conclusion
- •References
- •13 Radiation Therapy for Orbital and Adnexal Tumors
- •13.1 Indications
- •13.2 Radiation Therapy Terminology
- •13.3 Radiation Therapy Techniques
- •13.4 Radiation Therapy for Squamous Cell Carcinoma of the Eyelid
- •13.5 Adjuvant Radiation Therapy for Ocular Adnexal Tumors
- •13.6 Radiation Therapy for Optic Nerve Meningiomas and Orbital Rhabdomyosarcomas
- •13.7 Toxic Effects of Radiation Therapy
- •13.8 Summary
- •References
- •14.1 Historical Perspective
- •14.2 Presentation and Workup
- •14.4 Genetics
- •14.5 Pathologic Features
- •14.6 Treatment Options
- •14.6.1 General Considerations
- •14.6.2 Enucleation
- •14.6.3 Chemoreduction
- •14.6.4 Subtenon (Subconjunctival) Chemotherapy
- •14.6.5 Unilateral Disease
- •14.6.6 Bilateral Disease
- •14.7 Focal Therapies
- •14.7.1 Cryotherapy
- •14.7.2 Laser Photocoagulation
- •14.7.3 Brachytherapy
- •14.7.4 Thermotherapy
- •14.7.5 Radiation Therapy
- •14.8 Multi-institutional Clinical Trials
- •14.9 Animal Models of Retinoblastoma
- •14.10 Gene Transfer Technology for Treatment of Retinoblastoma
- •14.11 Future Development
- •References
- •15 Management of Uveal Melanoma
- •15.1 Epidemiology
- •15.2 Clinical Features
- •15.3 Diagnosis
- •15.4 Staging and Prognostic Factors
- •15.5 Background Studies
- •15.6 Overview of Management
- •15.7 Brachytherapy
- •15.8 Charged-Particle Radiotherapy
- •15.9 Surgical Techniques
- •15.9.1 Uveal Resection
- •15.9.2 Enucleation
- •15.9.3 Transpupillary Thermotherapy
- •15.9.4 Pathologic Assessment
- •15.9.5 Histologic Examination
- •15.10 Conclusion
- •References
- •16 Uveal Metastases from Solid Tumors
- •16.1 Introduction
- •16.2 Patient Characteristics
- •16.3 Symptoms
- •16.4 Clinical Features
- •16.5 Diagnosis
- •16.6 Treatment
- •16.6.1 Observation
- •16.6.2 External-Beam Radiation Therapy
- •16.6.3 Chemotherapy
- •16.6.4 Plaque Brachytherapy
- •16.6.5 Transpupillary Thermotherapy
- •16.6.6 Enucleation
- •16.7 Prognosis
- •16.8 Conclusions
- •References
- •17 Vascular Tumors of the Posterior Pole
- •17.1 Introduction
- •17.3 Circumscribed Choroidal Hemangioma
- •17.4 Management of Posterior Choroidal Hemangiomas
- •17.5 Acquired Vasoproliferative Tumors of the Retina
- •17.6 Conclusions
- •References
- •18 Reconstructive Surgery for Eyelid Defects
- •18.1 Introduction
- •18.2 General Principles
- •18.3 Eyelid Defects Not Involving the Eyelid Margin
- •18.4 Small Defects Involving the Lower Eyelid Margin
- •18.5 Moderate Defects Involving the Lower Eyelid Margin
- •18.6 Large Defects Involving the Lower Eyelid Margin
- •18.7 Small Defects Involving the Upper Eyelid Margin
- •18.8 Moderate Defects Involving the Upper Eyelid Margin
- •18.9 Large Defects Involving the Upper Eyelid Margin
- •18.10 Lateral Canthal Defects
- •18.11 Medial Canthal Defects
- •References
- •19.1 Introduction
- •19.2 Anatomy
- •19.3 Causes of Obstruction
- •19.4 Evaluation
- •19.5 Treatment
- •References
- •20.1 Introduction
- •20.2 Ectropion
- •20.2.1 Ectropion Due to Facial Nerve Paralysis
- •20.2.2 Cicatricial Ectropion
- •20.3 Entropion
- •20.4 Ptosis
- •20.5 Eyelid Retraction
- •20.6 Periorbital Edema Secondary to Imatinib Mesylate
- •References
- •21.1 Introduction
- •21.2 Anatomic Considerations
- •21.2.1 Orbital Margin
- •21.2.2 Nasal and Paranasal Sinuses
- •21.2.3 The Lacrimal System
- •21.2.4 Maxilla
- •21.3 Repair of Orbital Defects
- •21.3.1 Overview of Approaches
- •21.3.1.1 Maxillectomy with Orbital Exenteration
- •21.3.1.2 Maxillectomy Without Orbital Exenteration
- •21.3.2 Types of Maxillary Defects and Strategies for Their Repair
- •21.3.2.1 Type I Defect
- •21.3.2.2 Type II Defects
- •21.3.2.3 Type III Defects
- •21.3.2.4 Type IV Defects
- •21.3.3 Reconstruction After Orbital Exenteration
- •21.4 Conclusion
- •References
- •22.1 Introduction
- •22.2 Surgical Technique
- •22.2.2 Resection of Optic Nerve in Patients with Retinoblastoma
- •22.2.3 Maintenance of Globe Integrity
- •22.3 Choice of Implant
- •22.4 Management of the Anophthalmic Socket After Enucleation and Radiation Therapy
- •22.4.1 Patients with Retinoblastoma
- •22.4.2 Patients with Uveal Melanoma with Microscopic Extrascleral Extension
- •22.4.3 Patients with Head and Neck Cancer
- •22.5 Evisceration
- •References
- •23.2 Indications
- •23.3 Preoperative Evaluation
- •23.4 Surgical Techniques of Orbital Exenteration
- •23.5 Reconstructive Options
- •23.6 Surgical Complications
- •23.7 Rehabilitation After Orbital Exenteration
- •Suggested Readings
- •24.1 Introduction
- •24.2 Relevant Anatomy
- •24.3 Clinical Evaluation
- •24.3.1 Evaluation of Muscle Function
- •24.3.2 Evaluation of Lacrimal Gland and Lacrimal Drainage System Function
- •24.4 Medical Management
- •24.5 Surgical Management
- •24.5.1 Treatment of Lagophthalmos and Exposure Keratopathy
- •24.5.2 Treatment of Lower Eyelid Laxity and Ectropion
- •24.5.3 Reanimation of the Midface
- •24.5.3.1 Static Reanimation
- •24.5.3.2 Dynamic Reanimation
- •24.5.4 Options for Correction of Brow Ptosis
- •24.5.5 Additional Procedures for Management of Facial Droop
- •24.6 Special Circumstances in Cancer Patients with Facial Nerve Paralysis
- •24.7 Conclusion
- •References
- •25.1 Introduction
- •25.4 Conclusions and Recommendations
- •References
- •26 Lacrimal and Canalicular Toxicity
- •26.1 Introduction
- •26.2 5-Fluorouracil
- •26.4 Docetaxel
- •26.5 Epiphora Associated with Other Chemotherapeutic Drugs
- •26.6 Conclusions
- •References
- •27.1 Introduction
- •27.2 Orbital, Periorbital, and Orbital Teratogenic Side Effects by Individual Drug
- •27.2.1 Busulfan
- •27.2.2 Capecitabine
- •27.2.3 Carmustine
- •27.2.4 Cetuximab
- •27.2.5 Cisplatin
- •27.2.6 Cyclophosphamide
- •27.2.7 Cytarabine
- •27.2.8 Docetaxel
- •27.2.9 Doxorubicin
- •27.2.10 Erlotinib
- •27.2.11 Etoposide
- •27.2.12 Fluorouracil
- •27.2.13 Imatinib Mesylate
- •27.2.14 Interferons
- •27.2.15 Interleukin-2, Interleukin-3, and Interleukin-6
- •27.2.16 6-Mercaptopurine
- •27.2.17 Methotrexate
- •27.2.18 Mitomycin C
- •27.2.19 Mitoxantrone Dihydrochloride
- •27.2.20 Plicamycin
- •27.2.21 Thiotepa
- •27.2.22 Vincristine
- •27.3 Summary
- •References
- •28.1 Introduction
- •28.2 Epidemiology
- •28.2.1 Bacterial
- •28.2.2 Viral
- •28.2.3 Fungal
- •28.3 Pathogenesis and Host Defense
- •28.4 Ocular and Orbital Manifestations of Infection
- •28.4.1 Bacterial
- •28.4.2 Viral
- •28.4.3 Fungal
- •28.4.3.1 Candida Species
- •28.4.3.2 Aspergillus Species
- •28.4.3.3 Other Fungal Species
- •28.5 Conclusion
- •References
- •29.1 Introduction
- •29.2 Ophthalmologic Findings with CN III, IV, and VI Palsies
- •29.3 CN III, IV, and VI Palsies due to Primary Cranial Nerve Neoplasms and Direct Extension from Primary Brain, Brain Stem, or Skull base Tumors
- •29.4 CN III, IV, and VI Palsies due to Metastasis to the Brain, Brain, Stem and Skull Base from Distant Sites
- •29.5 Cranial Nerve III, IV, and VI Palsies due to Head and Neck Cancers
- •29.6 Cranial Nerve III, IV, and VI Palsies due to Leptomeningeal Disease
- •29.7 Other Causes of CN III, IV, and VI Palsies in Cancer Patients
- •29.8 Conclusion
- •References
- •30 Skull Base Tumors
- •30.1 Introduction
- •30.2 Anatomy of the Skull Base
- •30.3 Imaging and Diagnosis of Skull Base Tumors
- •30.4 Skull Base Tumors and Neuro-ophthalmic Correlations
- •30.4.1 Esthesioneuroblastoma
- •30.4.2 Chordoma
- •30.4.3 Craniopharyngioma
- •30.4.4 Meningioma
- •30.4.5 Sinonasal and Nasopharyngeal Tumors
- •30.4.6 Schwannoma
- •30.4.7 Pituitary Tumors
- •30.4.8 Myeloma
- •30.4.9 Paraganglioma
- •30.4.10 Metastases
- •References
- •31.1 Optic Pathway Gliomas
- •31.1.1 Demographics and Presentation
- •31.1.2 Histopathology
- •31.1.3 Imaging and Lesion Location
- •31.1.4 Differential Diagnosis
- •31.1.5 Management
- •31.1.6 Prognosis
- •31.2 Optic Nerve Sheath Meningiomas
- •31.2.1 Incidence
- •31.2.2 Histology and Pathophysiology
- •31.2.3 Clinical Presentation
- •31.2.4 Imaging
- •31.2.5 Treatment
- •References
- •32 Leptomeningeal Disease
- •32.1 Introduction
- •32.2 Epidemiology
- •32.3 Clinical Presentation
- •32.3.1 LMD due to Solid Tumors
- •32.3.2 LMD due to Hematogenous Tumors
- •32.3.3 LMD due to Primary Brain Tumors
- •32.4 Diagnosis
- •32.4.1 Radiographic Imaging
- •32.4.2 Optic Neuropathies in LMD
- •32.5 Treatment
- •32.6 Prognosis
- •32.7 Conclusion
- •References
- •33 Paraneoplastic Visual Syndromes
- •33.1 Introduction
- •33.2 Pathogenesis
- •33.3 Carcinoma-Associated Retinopathy
- •33.4 Carcinoma-Associated Cone Dysfunction Syndrome
- •33.5 Melanoma-Associated Retinopathy
- •33.6 Autoimmune Retinopathy
- •33.7 Paraneoplastic Optic Neuropathy
- •33.8 Diagnostic Testing
- •33.9 Differential Diagnosis
- •33.10 Treatment and Prognosis
- •33.11 Conclusion
- •References
- •34.1 Introduction
- •34.2 NF1 and the Optic Pathway
- •34.3.1 Description and Clinical Issues
- •34.3.2 Evaluation and Management
- •34.4 Intraorbital Optic Nerve Glioma
- •34.4.1 Description and Clinical Issues
- •34.4.2 Evaluation and Management
- •34.5 Chiasmal and Hypothalamic Glioma
- •34.5.1 Description and Clinical Issues
- •34.5.2 Evaluation and Management
- •34.6 Intraparenchymal Astrocytoma
- •34.6.1 Description and Clinical Issues
- •34.6.2 Evaluation and Management
- •34.7 Conclusion
- •References
- •35 Other Optic Nerve Maladies in Cancer Patients
- •35.1 Introduction
- •35.2 Optic Neuropathies Related to Elevated ICP
- •35.2.1 Causes of Elevated ICP
- •35.2.2 Treatment of Elevated ICP
- •35.4 Optic Neuropathies Caused by Drugs
- •35.4.1 Optic Disc Edema Secondary to Drug-Induced Elevated ICP
- •35.4.1.1 Retinoids
- •35.4.1.2 Imatinib Mesylate
- •35.4.1.3 Cyclosporine A
- •35.4.1.4 Cytarabine
- •35.4.2 Elevated ICP Secondary to Cerebral Venous Thrombosis
- •35.4.2.1 Cisplatin
- •35.4.2.2 L-Asparaginase
- •35.4.3 Optic Disc Edema Usually Without Elevated ICP
- •35.4.3.1 Cisplatin
- •35.4.3.2 Carboplatin
- •35.4.3.3 Carmustine
- •35.4.3.4 Vincristine
- •35.4.3.5 5-Fluorouracil
- •35.4.3.6 Cyclosporine A
- •35.4.3.7 Tacrolimus
- •35.4.4 Optic Neuropathy Without Disc Edema
- •35.4.4.1 Fludarabine
- •35.4.4.2 Tacrolimus
- •35.4.4.3 Paclitaxel
- •35.4.4.4 Methotrexate
- •35.4.4.5 Cytarabine
- •35.5 Optic Neuropathies Caused by Radiation
- •References
- •36 Management of Endogenous Endophthalmitis
- •36.1 Introduction
- •36.2 Epidemiology
- •36.3 Microbiology
- •36.4 Clinical Manifestations and Diagnosis
- •36.5 Treatment
- •36.5.1 Bacterial Endophthalmitis
- •36.5.2 Fungal Endophthalmitis
- •36.5.2.1 Yeast Endophthalmitis
- •36.5.2.2 Mold Endophthalmitis
- •36.6 Prognosis
- •36.7 Summary
- •References
- •37 Viral Retinitis in the Cancer Patient
- •37.1 Introduction
- •37.2 Epidemiology
- •37.3 Clinical Features
- •37.3.1 CMV Retinitis
- •37.3.2 Acute Retinal Necrosis
- •37.3.3 Progressive Outer Retinal Necrosis
- •37.4 Treatment
- •37.4.1 CMV Retinitis
- •37.4.1.1 Intravitreal Injections
- •37.4.1.2 Ganciclovir Implant
- •37.4.2 Acute Retinal Necrosis
- •37.4.3 Progressive Outer Retinal Necrosis
- •37.5 Role of Vitreoretinal Surgery in Viral Retinitis
- •37.5.1 Argon Laser Photocoagulation
- •37.5.2 Retinal Detachment Repair
- •37.6 Prognosis
- •37.6.1 CMV Retinitis
- •37.6.2 Acute Retinal Necrosis
- •37.6.3 Progressive Outer Retinal Necrosis
- •37.7 Conclusion
- •References
- •38.1 Introduction
- •38.2 Indications for Diagnostic Vitrectomy
- •38.2.1 Vitreous Biopsy
- •38.2.2 Uveal Biopsy
- •38.3 Preoperative Considerations
- •38.3.1 Thrombocytopenia
- •38.3.2 Anesthesia
- •38.4 Vitreous Biopsy
- •38.4.1 Technique
- •38.4.2 Effect of Vitrector Gauge on Vitreous Sample
- •38.5 Uveal Biopsy
- •38.5.1 Technique
- •38.5.2 Complications
- •38.5.3 Collaboration with Pathology
- •38.6 Pathologic Processing
- •38.6.1 Cytology
- •38.6.2 Interleukin Measurement
- •38.6.3 Polymerase Chain Reaction
- •38.6.4 Genetic Analysis
- •38.6.5 Cytogenetic Uveal Melanoma Studies
- •38.7 Results of Diagnostic Vitrectomy
- •38.7.1 Common Diagnoses
- •38.7.2 Diagnostic Utility
- •38.8 Postoperative Considerations
- •38.9 Conclusion
- •References
- •39.1 Introduction and Epidemiology
- •39.2 Presentation and Diagnosis
- •39.3 Management
- •39.4 Future Considerations
- •39.5 Conclusions
- •References
- •Index
350 |
V.H. Ho and H.H. Ho |
28.5 Conclusion
Patients with cancer vary both in terms of underlying malignancy and in terms of the level of immunosuppression. Multiple predisposing factors may exist, increasing the spectrum of likely pathogens. The recognition and treatment of infection in immunocompromised patients are very important. Collaboration between different specialties is crucial in managing patients with orbital or ocular infection. Not only can the visual outcome of ocular and orbital infection be poor, but associated systemic involvement and septicemia may be life-threatening.
References
1.Marchetti O, Calandra T. Infections in the neutropenic cancer patient. In: Cohen J, Powderly WG, editors. Infectious Diseases, second edition. New York, NY: Mosby, 2004:1077–93.
2.Segal BH, Walsh TJ, Gea-Banacloche J, et al. Infections in the cancer patient. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer Principles and Practice of Oncology, seventh edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2005:2461–2511.
3.Bannister B, Gillespie S, Jones J. Infections in immunocompromised patients. In: Infection Microbiology and Management. Oxford: Blackwell, 2006:431–42.
4.Rolston KV. Infection in the neutropenic patient. In: Kantarjuan HM, Wolff RA, Koller CA, editors. The M. D. Anderson Manual of Medical Oncology. New York, NY: McGraw-Hill, 2006:957–66.
5.Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment. Lancet 2003;4:595–604.
6.Easty DL. Infection in the compromised eye. Trans Am Ophthalmol Soc 1986;105:61–8.
7.Bal AM, Gould IM. Empirical antimicrobial treatment for chemotherapy-induced febrile neutropenia. Int J Antimicrob Agents 2007;29:501–9.
8.Oken MM, Pomeroy C, Weisdorf D, et al. Prophylactic antibiotics for the prevention of early infection in multiple myeloma. Am J Med 1996;100:624–8.
9.Noskin GA. Prevention of infection in immunocompromised hosts. In: Management of Infectious Complications in Cancer Patients. Boston: Kluwer, 1998:223–46.
10.Kowalski RP, Karenchak LM, Romanowski EG. Infectious disease: changing antibiotic susceptibility. Ophthalmol Clin North Am 2004;16:1–9.
11.Bodey GP, Chamaly RF, Kontoyiannis DP. Fungal and viral infections in cancer patients. In: Kantarjuan HM, Wolff RA, Koller CA, editors. The M. D. Anderson Manual of Medical Oncology. New York, NY: McGraw-Hill, 2006:967–92.
12.Samonis G, Bafaloukos D. Fungal infections in cancer patients: an escalating problem. In Vivo 1992;6:183–94.
13.Powles RL. Systemic fungal infections: major problems in cancer patients. Indian J Cancer 1994;31:180–4.
14.Mays SR, Bogle MA, Bodey GP. Cutaneous fungal infections in the oncology patient. Am J Clin Dermatol 2006;7:31–43.
15.Cornely OA, Bohme A, Reichert D, et al. Risk factors for breakthrough invasive fungal infection during secondary prophylaxis. J Antimicrob Chemother 2008;61:939–46.
16.Anaissie E. Opportunistic mycoses in the immunocompromised host: experience at a cancer center and review. Clin Infect Dis 1992;14:S43–53.
17.Herbrecht R, Denning DW, Patterson TF. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408–15.
18.Rolston KV, Bodey GP, Safdar A. Polymicrobial infection in patients with cancer: an underappreciated and underreported entity. Clin Infect Dis 2007;45:228–33.
28 Ocular and Orbital Infections in the Immunocompromised Cancer Patient |
351 |
19.Jack MK, Hicks JD. Ocular complications in high-dose chemoradiotherapy and marrow transplantation. Ann Ophthalmol 1981;13:709–11.
20.Lynn WA, Lightman S. The eye in systemic infection. Lancet 2004;364:1439–50.
21.Khan A, Okhravi N, Lightman S. The eye in systemic sepsis. Clin Med 2002;2:444–8.
22.Mahajan VM. Acute bacterial infections of the eye: their aetiology and treatment. Br J Ophthalmol 1983;67:191–4.
23.Guembel HOC, Ohrloff C. Opportunistic infections of the eye in immunocompromised patients. Ophthalmologica 1997;211:53–61.
24.Bialasiewicz AA, Knospe V, Richard G. Ocular infections in the immunocompromised host. Dev Ophthalmol 1999;30:203–19.
25.Sridhar MS, Laibson PR, Rapuano CJ, et al. Infectious crystalline keratopathy in an immunosuppressed patient. CLAO J 2001;27:108–10.
26.Jain ML, Garg AK. Metastatic endophthalmitis in a patient with major burns: a rare complication. Burns 1995;21:72–3.
27.Tabbara KF, Juffali F, Matossian RM. Bacillus laterosporus endophthalmitis. Arch Ophthalmol 1977;95:2187–9.
28.Hornblass A, To K, Coden DJ, et al. Endogenous orbital cellulites and endogenous endophthalmitis in subacute bacterial endocarditis. Am J Ophthalmol 1989;108:196–7.
29.Li S, Perlman JI, Edward DP, et al. Unilateral blastomyces dermatitidis endophthalmitis and orbital cellulites. Ophthalmology 1998;105:1466–70.
30.Maccheron LJ, Groeneveld ER, Ohlrich SJ, et al. Orbital cellulitis, panophthalmitis, and ecthyma gangrenosum in an immunocompromised host with Pseudomonas septicemia. Am J Ophthalmol 2004;137;176–8.
31.Lakosha H, Pavlin CJ, Lipton J. Subretinal abscess due to Nocardia farcinica infection. Retina 2000;20:269–74.
32.Tsai PS, DeAngelis DD, Spencer WH, et al. Bacillary angiomatosis of the anterior orbit, eyelid, and conjunctiva. Am J Ophthalmol 2002;134:433–4.
33.Patel SJ, Petrarca R, Shah SM, et al. Atypical bartonella henselae chorioretinitis in an immunocompromised patient. Ocul Immunol Inflamm 2008;16:45–9.
34.Koreishi AF, Schechter BA, Karp CL. Ocular infections caused by Providencia rettgeri. Ophthalmology 2006;113:1463–6.
35.Hoerni B, Vallat M, Durand M, et al. Ocular toxoplasmosis and Hodgkin’s disease. Arch Ophthalmol 1978;96:62–3.
36.Shah MK, Sebti A, Kiehn TE, et al. Mycobacterium haemophilum in immunocompromised patients. Clin Infect Dis 2001;33:330–7.
37.Millar MJ, Bulliard C, Balachandran C, et al. Mycobacterium haemophilum infection presenting as filamentary keratopathy in an immunocompromised adult. Cornea 2007;26:764–6.
38.Modi D, Pyatetsky D, Edward DP, et al. Mycobacterium haemophilum, a rare cause of endophthalmitis. Retina 2007;27:1148–51.
39.Ali S, Sivak-Callcot JA, Khakoo R, et al. Mycobacterium fortuitum infection masquerading as an orbital mass. Ophthal Plast Reconstr Surg 2007;23:327–9.
40.Bansal R, Tutrone WD, Weinberg JM. Viral skin infections in the elderly. Drugs Aging 2002;19:503–14.
41.Khan BF, Pavan-Langston D. Clinical manifestations and treatment modalities in herpes simplex virus of the ocular anterior segment. Int Ophthalmol Clin 2004;44:103–33.
42.Foster WJ, Krause MD, Custer PL. Herpes simplex virus dacryoadenitis in an immunocompromised patient. Arch Ophthalmol 2003;121:911–12.
43.Lightman S, Marsh RJ, Powell D. Herpes zoster ophthalmicus: a medical review. Br J Ophthalmol 1981;65:539–41.
44.Greven CM, Singh T, Stanton CA, et al. Optic chiasm, optic nerve, and retinal involvement secondary to varicella-zoster virus. Arch Ophthalmol 2001;119:608–10.
45.Friedlander SM, Rahhal FM, Ericson L, et al. Optic neuropathy preceding acute retinal necrosis in acquired immunodeficiency syndrome. Arch Ophthalmol 1995;114:1481–5.
352 |
V.H. Ho and H.H. Ho |
46.Lee MS, Cooney EL, Stoessol KM, et al. Varicella zoster virus retrobulbar optic neuritis proceeding retinitis in patients with acquired immune deficiency syndrome. Ophthalmology 1998;105:467–71.
47.Long HM, Dick A. Presumed CMV associated necrotizing retinopathy in a non-HIV immunocompromised host. Clin Exp Ophthalmol 2005;33:330–5.
48.Foster RE, Peterson MR, Neuss MN, et al. Progressive outer retinal necrosis syndrome in a lymphoma patient with good visual outcome. Am J Ophthalmol 2001;132:117–20.
49.Kalpoe JS, van Dehn CE, Bollemeijer JG, et al. Varicella zoster virus (VZV)-related progressive outer retinal necrosis (PORN) after allogeneic stem cell transplantation. Bone Marrow Transplant 2005;36:467–9.
50.Westeneng AC, Rothova A, De Boer JH, et al. Infectious uveitis in immunocompromised patients and the diagnostic value of polymerase chain reaction and Goldmann-Witmer coefficient in aqueous analysis. Am J Ophthalmol 2007;144:781–5.
51.Akpek EK, Kent C, Jakobiec F, et al. Bilateral acute retinal necrosis caused by cytomegalovirus in an immunocompromised patient. Am J Ophthalmol 1999;127:93–5.
52.Derzko-Dzulynsky LA, Berger AR, Berinstein NL. Cytomegalovirus retinitis and lowgrade non-Hodgkin’s lymphoma: case report and review of the literature. Am J Hematol 1998;57:228–32.
53.Duker JS, Blumenkranz MS. Diagnosis and management of the acute retinal necrosis syndrome (ARN). Surv Ophthalmol 1995;35:327–43.
54.Pollard RB, Egbert PR, Gallagher JG, et al. Cytomegalovirus retinitis in immunosuppressed hosts. I. Natural history and effects of treatment with adenine arabinoside. Ann Intern Med 1980;93:655–64.
55.Egbert PR, Pollard RB, Gallagher JG, et al. Cytomegalovirus retinitis in immunosuppressed hosts. II. Ocular manifestation. Ann Intern Med 1980;93:664–70.
56.Segal BH, Almyroudis NG, Battiwalla M, et al. Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts. Clin Infect Dis 2007;44:402–9.
57.Thursky KA, Playford EG, Seymour JF, et al. Recommendations for the treatment of established fungal infections. Intern Med J 2008;38:496–520.
58.Hariprasad SM, Mieler WF, Lin TK, et al. Voriconazole in the treatment of fungal eye infections: a review of current literature. Br J Ophthalmol 2008;92:871–8.
59.de O Machado O, Goncalves R, Fernandes EM, et al. Bilateral aspergillus endophthalmitis in a patient with chronic lymphocytic leukaemia. Br J Ophthalmol 2003;87:1429–30.
60.Hilal AA, Taj-Aldeen SJ, Mirghani AH. Rhinoorbital mucormycosis secondary to Rhizopus oryzae: a case report and literature review. Ear Nose Throat J 2004;83:556–62.
61.Jeevanan J, Gendeh BS, Faridah HA, et al. Rhino-orbito-cerebral mucormycosis: a treatment dilemma. Med J Malaysia 2006;61:106–8.
62.Louie T, el Baba F, Shulman M, et al. Endogenous endophthalmitis due to fusarium: case report and review. Clin Infect Dis 1994;18:585–8.
63.O’Doherty M, Hannan M, Fulcher T. Voriconazole in the treatment of fungal osteomyelitis of the orbit in the immunocompromised host. Orbit 2005;24:285–9.
64.Wood GM, McCormack JG, Muir DB, et al. Clinical features of human infection with Scedosporium inflatum. Clin Infect Dis 1992;14:1027–33.
65.Gluckman SJ, Ries K, Abrutyn E. Allescheria (Petriellidium) boydii sinusitis in a compromised host. J Clin Microbiol 1977;5:481–4.
66.Anderson RL, Carroll TF, Harvey JT. Petriellidium (Allescheria) boydii orbital and brain abscess treated with intravenous miconazole. Am J Ophthalmol 1984;97:771–5.
67.Jones J, Katz SE, Lubow M. Scedosporium apiospermum of the orbit. Arch Ophthalmol 1999;117:27203.
Part V
Neuro-ophthalmic Manifestations
of Cancer
Section Editor: Jade S. Schiffman
