Kenali Ragam Tumor Mata dan

Waspadai Tanda Bahayanya

Mengenal Tumor Palpebra dan Intra Okuli

Delfitri Lutfi
Reconstruction, Oculoplasty, Oncology Division - Department of Ophthalmology
Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital
Surabaya
 Eye Tumor
Extraocular

intraocular

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Eyelid Tumor
 Introduction
2012 - 2015

BCC SGC SCC MM Lymphoma

37.50% 39.29% 16.07% 5.36% 1.78%

Ophthalmic oncology clinic RSDS

• Any of the eyelid structures

• Anterior location and the ability to visualize both
anterior and posterior surfaces
• Tumors of the eyelid may develop posterior extension

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Symptoms of Eyelid Neoplasia

Sensory
Tenderness, itching, visual change
Structural
Asymetri, visible or palpable lesions
Functional
Keratopathy or tearing
Motor
Blepharoptosis, lagophthalmos
Secondary
Pigmentation, lymphadenopathy
https://www.verywellhealth.com/
 Ulceration,
Fine Signs suggesting of bleeding, crusting,
telangiectasia margin notch
Malignant Eyelid Tumor

Nodularity, heaped-up,
pearly translucency

Courtesy of Ophthalmic Oncology Clinic RSDS

Slow, painless Destruction of normal

loss of cilia
growth of a lesion eyelid margin architecture
Courtesy of Ophthalmic Oncology Clinic RSDS Courtesy of Ophthalmic Oncology Clinic RSDS

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 Signs suggesting of
Malignant Eyelid Tumor
Courtesy of Ophthalmic Oncology Clinic RSDS
Courtesy of Ophthalmic Oncology Clinic RSDS

Irregular
pigmentary Destruction of normal
eyelid margin architecture
changes
Courtesy of Ophthalmic Oncology Clinic
RSDS

loss of cilia

Slow, painless
growth of a lesion
Courtesy of Ophthalmic Oncology Clinic RSDS
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 Examination
Point out smaller lesions using a
hand mirror
Characterize the appearance of the
lesion and anatomical deformities
Measured lesion dimensions using
a ruler or slit lamp beam
Palpate the mobility of the lesion
and associated tenderness
• Spread directly → lacrimal gland, orbit, or
lacrimal apparatus
• Primary tumors → only eyelid signs and
symptoms
• The structure and function of the orbit and
ocular adnexal tissues should be evaluated.
• Palpate for preauricular, submandibular, and
supraclavicular adenopathy
• Cranial nerves V and VII → to assess for
possible perineural spread
 Eye Examination
• Detecting findings caused by or associated with the
eyelid lesion
• Conjunctiva and cornea → signs of mechanical or
exposure keratoconjunctivitis using the slit lamp
Courtesy of Ophthalmic Oncology Clinic RSDS
• Sclera and episclera → pigmentary changes during
the evaluation of an eyelid nevus
• Direct intraocular extension is rare → funduscopy
should be performed to observe for signs of ocular
or orbital involvement (choroidal folds, venous
congestion) in suspected cases

Courtesy of Ophthalmic Oncology Clinic RSDS

 Diagnostic
Variable clinical presentation

Clinical impression !

Growth rate, surface

Recurrence

Biopsy and histopathology examination → MANDATORY

Perineural spread and orbital, nasal cavity, and brain invasion → IMAGING

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 Surgical Management
• THE GOAL → to achieve complete surgical excision with clear surgical
margins
• Prevent recurrence → Wide margins at least 5 mm.
Excision biopsy
small Frozen section
primary clossure
Lesion
Incisional biopsy / Wide excision
large punch biopsy frozen section
(HISTOPA) reconstruction

Reconstruction → when all margins are found to be free of tumor!!

 Management
Courtesy of Ophthalmic Oncology Clinic RSDS

• Cryotherapy→ can help to achieve good tumor control in some cases not amenable to
surgical resection
• Radiotherapy → palliative treatment for aggressive recurrent lesions or for patients
unable to undergo surgery
• Medial canthal area → removal of the lacrimal drainage system → reconstruction
should not be undertaken until it is established that the patient is tumor free
• Unresectable orbital tumor or extensive orbital invasion → orbital exenteration
• Systemic chemotherapy → regional spread to lymph nodes and hematogenous
metastasis to distant organs
• Sentinel lymph node biopsy → Regional lymph node metastases → prognostic factor
Handling eyelid specimens
Courtesy of Ophthalmic Oncology Clinic RSDS
Intraocular Tumor
 Tumor Intraokular
• Primer and secunder
• Adult → uveal melanoma and lymphoma
• Children → retinoblastoma.

American Cancer Society, 2021 17

Intraocular tumor symptoms (adult)

• Generally no signs/ symptoms of inflammation like pain and redness

• Most common → blurred vision
• Floaters which are intermittent, Seeing flashing lights (photopsia)
• Loss of peripheral vision
• Dark spot or change in iris colour or pupil shape
• Eye swelling, eye redness (lymphoma)
• Eye pain due to increased of intraocular pressure
• Bulging eye
• Unknown eyeball content prolapse
• Common symptoms of lymphoma, like fatigue, night sweats, and weight loss
Uveal Melanoma
To Find Small Ocular Melanoma Using
Helpful Hints Daily
• T: Thickness > 2 mm
• F: Fluid (subretinal)
• S: Symptoms (decreased vision, flashes or floaters)
• O: Orange pigment (presence of)
• M: Margin within 3 mm of the optic disc
• UH: Ultrasonographic hollowness
• H: Absence of surrounding halo. Nevi usually show a surrounding clear halo
consisting of atrophied retina.
• D: Absence of drusen. Drusen are chronic changes seen more commonly in
slow growing lesions such as choroidal nevi than in melanomas.
Finger T, 2016
Lymphoma

systemic evaluation to rule out CNS involvement

Typical OCT in PVRL showing sub-RPE hyperreflectivity

and nodular RPE elevations
Imaging
 Retinoblastoma
Common presenting features

1. Leucocoria 56%
2. Strabismus 20%
3. Red painful eye 7%
4. Poor vision 5%
5. Asimptomatic 3%
6. Orbital cellulitis 3% 24

7. Unilateral mydriasis 2%
8. Hyphema 1%
Retinoblastoma intraokuli
 Examination
✓ Funduscopy (funduscopy direct/indirect, RetCam)
✓ Ultrasonography
✓ Radiology CT Scan / MRI

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TERAPI

Multi Disiplin
- Dokter
- Okularist
 Treatment Option
• Medical
✓ Sistemic Chemotherapy
✓ Intra-arterial Chemotherapy
✓ Intravitreal Chemotherapy
• Surgical
✓ Enucleation
✓ Exenteration
• External Beam Radiotherapy
• Local Therapy Intraocular
✓ Thermotherapy
✓ Laser photocoagulation
✓ Cryotherapy
✓ Plaque Brachitherapy
 Enucleation – special considerations
✓ Avoid perforation of the eye
✓ Inspect enucleated eye for macroscopic
extraocular extension and optic nerve
involvement
✓ Avoid bio-integrated implant if postoperative
radiotherapy is necessary
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Deteksi Leukokoria

• Cara biasa → 8% dari kasus

• Aplikasi → sensivitas > 80% pd
anak usia < 2 thn
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 Save life

Take Home Message Save

eye

A systematic approach → diagnose and Save

vision
treat eye cancers efficiently
Clinical diagnosis is imperfect →
Histopathology remains the gold
standard
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Successful treatment of cancer depends
upon its early detection and intervention
Acknowledgement
Ophthalmic Oncology Clinic dr.
Soetomo General Academic
Hospital Surabaya patients