ConditionEyes & vision
Orbital Tumors (Eye Socket Tumors)
Orbital tumors are abnormal growths in the orbit, the bony socket that holds the eye, its muscles, nerves, fat and tear gland. Most are benign, such as vascular malformations, dermoid cysts and nerve sheath tumors, but some are cancers such as lymphoma, rhabdomyosarcoma or spread from cancer elsewhere. The typical sign is a slowly bulging or displaced eye, sometimes with double vision or blurred vision. MRI or CT and often a biopsy guide treatment.
Also called: Eye socket tumors, orbital masses, orbital neoplasms, orbital lesions
At a glance
- What it is
- Any mass in the eye socket, benign or malignant, starting there or spreading from nearby or distant sites.
- Commonest in adults
- Cavernous venous malformation (benign) and lymphoma (malignant). Lacrimal gland tumors, meningiomas and metastases also occur.
- Commonest in children
- Dermoid cysts and infantile hemangiomas (benign), and rhabdomyosarcoma (malignant).
- Main sign
- One eye slowly pushed forward (proptosis) or sideways, often painless.
- Diagnosis
- Eye exam, MRI or CT scan, and biopsy.
- Treatment
- Observation, surgery, radiation, chemotherapy or medicine, depending on the type.
When to get help
Call 911 or go to the ER
- Rapid bulging of one eye with pain, fever, red swollen eyelids or reduced eye movement (possible orbital cellulitis)
- Sudden loss of vision in one eye
See a doctor within a day or two
- A child with an eye that is bulging or displaced over days to weeks, or a swollen eyelid that keeps growing
- Double vision, reduced vision or colors looking washed out in one eye with a bulging eye
- A known cancer and new eye bulging, double vision or drooping eyelid
- Bruising around both eyes in a young child without injury
Book a routine appointment
- One eye that looks more prominent than the other in photos, slowly over months
- A painless lump at the outer upper corner of the eye socket
- A swollen upper eyelid with an S-shaped curve that does not go away
What orbital tumors are
The orbit is a closed, cone-shaped space. Because it cannot expand, any growth inside it pushes the eye forward (proptosis), down, up or sideways, or presses on the optic nerve and eye muscles. Doctors classify orbital tumors by:
- origin: primary (starting in the orbit), secondary (spreading from the eyelid, sinuses or brain) or metastatic (from a distant cancer)
- behavior: benign or malignant
- tissue: blood vessels, nerves, tear gland, lymphoid tissue, bone or muscle
Before considering a tumor, doctors also think about the commonest cause of a bulging eye in adults: thyroid eye disease. Infection (orbital cellulitis) and orbital inflammation can also mimic a tumor.
Common types by age
Adults
| Tumor | Behavior | Typical features |
|---|---|---|
| Cavernous venous malformation (formerly cavernous hemangioma) | Benign | Middle-aged adults, slow painless proptosis |
| Orbital lymphoma | Malignant, usually low grade | Older adults, painless "salmon-patch" or swelling, often under the upper lid |
| Lacrimal gland tumors | Benign (pleomorphic adenoma) or malignant (adenoid cystic carcinoma) | Swelling at the outer upper eyelid, eye pushed down and in. Pain suggests cancer |
| Meningioma | Usually benign | Middle-aged women, gradual vision loss when it involves the optic nerve sheath |
| Schwannoma and neurofibroma | Benign | Slow growth. Neurofibromas linked to neurofibromatosis |
| Metastases | Malignant | From breast, lung, prostate, kidney or melanoma. Rapid onset, pain, double vision |
| Spread from nearby | Malignant | Sinus, skin or eyelid cancers growing into the orbit |
Children
| Tumor | Behavior | Typical features |
|---|---|---|
| Dermoid cyst | Benign | Most common orbital mass in children. Firm, painless lump at the outer brow |
| Infantile hemangioma | Benign | Appears in the first weeks, grows for months, then shrinks |
| Lymphatic malformation | Benign | Can swell suddenly with bleeding or colds |
| Rhabdomyosarcoma | Malignant | Most common primary orbital cancer in children. Rapid bulging over weeks, often around age 5 to 7 |
| Optic pathway glioma | Usually low grade | Often linked to neurofibromatosis type 1. Gradual vision loss |
| Neuroblastoma metastasis | Malignant | Young children, bruising around the eyes ("raccoon eyes"), unwell |
Symptoms
- a bulging or displaced eye, usually one-sided
- eyelid swelling, drooping or an S-shaped lid
- a lump felt at the rim of the socket
- double vision as eye muscles are pushed or invaded
- blurred or reduced vision, dull colors or a blind spot, from optic nerve compression
- pain, numbness of the forehead or cheek (more typical of malignant or inflammatory masses)
- in children, a squint or lazy eye
Speed matters. Benign tumors usually grow over months or years. Rhabdomyosarcoma, metastases and inflammatory conditions change over days to weeks.
Diagnosis
- Eye examination: vision, color vision, pupils, eye movements, eye pressure, and measurement of proptosis with an exophthalmometer.
- MRI with contrast: the best scan for soft tissue and the optic nerve.
- CT scan: best for bone changes, calcium and planning surgery.
- Biopsy: a sample through a small incision confirms the type, unless imaging is characteristic and the mass can be removed completely.
- Further tests for cancer: blood tests, whole-body PET-CT, bone marrow tests for lymphoma, and searching for a primary cancer when a metastasis is found.
Specialists include oculoplastic and orbital surgeons, neuro-ophthalmologists and oncologists.
Treatment
- Observation: small, stable benign tumors that do not affect vision, such as many cavernous venous malformations, can be watched with periodic scans.
- Surgery (orbitotomy): removal through the eyelid, eyebrow, side wall or nose, depending on the location. Dermoid cysts and pleomorphic adenomas are removed whole, because rupture can cause inflammation or recurrence.
- Radiation therapy: highly effective for orbital lymphoma and used for meningiomas and some metastases.
- Chemotherapy: combined with radiation for rhabdomyosarcoma, which now has a high cure rate when confined to the orbit.
- Medicines: oral propranolol for problematic infantile hemangiomas, and targeted or immune therapies for some lymphomas and metastases.
- Exenteration (removing the eye and orbital contents) is reserved for aggressive cancers that cannot be controlled otherwise.
Outlook
Most benign orbital tumors have an excellent outlook after removal or monitoring, though vision can be affected if the optic nerve has been compressed for a long time. Low-grade orbital lymphoma and childhood orbital rhabdomyosarcoma respond very well to treatment. Metastatic tumors carry the outlook of the original cancer. Early assessment of a bulging eye protects vision.
Frequently asked questions
What are the symptoms of a tumor behind the eye?
The commonest is a slowly bulging eye on one side. Others include eyelid swelling or drooping, double vision, blurred or dim vision, a lump at the edge of the socket, and sometimes pain or numbness around the eye. Many benign tumors are painless.
Are most orbital tumors cancerous?
No. Most orbital tumors are benign, especially in children, where dermoid cysts and hemangiomas are most common. In adults, lymphoma is the most common malignant tumor, and cancers can also spread to the orbit from elsewhere. A scan and often a biopsy are needed to know for sure.
What causes an eye to bulge?
In adults the most common cause is thyroid eye disease, which usually affects both eyes. A bulging eye on one side can also be caused by an orbital tumor, orbital infection, inflammation or a blood vessel abnormality. New bulging always needs an eye exam and often a scan.
How are orbital tumors removed?
A surgeon reaches the tumor through a small cut hidden in the eyelid crease, eyebrow or inside the lid, through the side wall of the orbit, or through the nose with an endoscope. Recovery usually takes a few weeks, with bruising and swelling settling over that time.
Can an orbital tumor cause blindness?
It can if it presses on the optic nerve for a long time or invades the eye. That is why reduced vision, dull colors or a blind spot with a bulging eye need urgent assessment. Many people keep good vision with timely treatment.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology EyeWiki: Orbital Tumors
- American Society of Ophthalmic Plastic and Reconstructive Surgery: Orbital tumors (patient information)
- National Cancer Institute: Childhood Rhabdomyosarcoma Treatment (PDQ)
- Merck Manual: Orbital Tumors
- Cleveland Clinic: Orbital Tumors