¡¡¡¡Table 2  Treatment of primary benign orbital lesions£¨ÂÔ£©

¡¡¡¡Table 3  Postoperative complications£¨ÂÔ£©

¡¡¡¡Lymphangiomas are thin walled vascular channels, and hemodynamically isolated from the arterial and venous orbital circulation. They arouse curiosity because the orbit is normally devoid of lymphatic channels as well as lymphoid follicles. Wright et al[8] suggested that lymphagiomas are variant of venous malformations, but clinical, hemodynamic and histophathlogic studies strongly suggest that lymphangioª²mas are distinct orbital hamartomas. Two patients of superficial subcutaneous lymphangimas were presented with bluish coloured, small swelling, beneath the superionasal part of upper lid. The swelling was soft, reducible, and nonª²tender (Figure 3). The other 3 patients of deep seated lymphangiomas were presented with eccentric proptosis with bluish mass in the superior fornix and below the lid. The size of proptosis increased in one patient with the presence of upper respiratory tract infection, reflecting the proliferating lymphoid elements in the connective tissue trabeculas of the¡¡tumor. Two superficial small size lymphangiomas were excised surgically and in 2 deep lymphangiomas local intralesion steroid injection was given through conjunctiva and in one case with large proptosis lateral orbitotomy was done in which tumor was excised incompletely because of the deep infiltraª²tion of the tumor, and in remnant tissues local intralesion steroids injection was given (Figure 2).

¡¡¡¡Figure 2  Deep orbital haemangioma£¨ÂÔ£©

¡¡¡¡A: Fortyª²five years old male showing left eye proptosis; B: Photograph of the orbital mass (reddish, fleshy, 25x17mm size) of the same patient removed through lateral orbitotomy

¡¡¡¡Figure 3  Superficial lyphangioma of eye lid  £¨ÂÔ£©

¡¡¡¡A: Seven months old boy with superficial, soft, reducible, nontender subcutaneous swelling involving left eye lids; B: The CT scan (axial view) of the same child showing the soft tissue swelling on the medial side of the left eye

¡¡¡¡Figure 4  Superficial orbital varix £¨ÂÔ£©

¡¡¡¡A: Thirty years old female with right eye superficial orbital varix at resting position; B: The same patient with Valsalva¬ðs maneuver showing classical finding of dilatation of blood vessels

¡¡¡¡Orbital varices are anomalies consist of either a single segmental irregular dilatation of a vein or a tangle of ectatic vascular channels. Varices may be primary (congenital) lesions, secondary (acquired) lesions or the sequelae of intracranial or orbital arteriovenous malformations[9]. Lesions with prominent connections to the systemic venous system are distensible and respond to changes in the venous circulation. They present with classical findings of proptosis and pain, which increase with Valsalva¬ðs maneuver[10]. In our study one patient presented with superficial lid varix (Figure 4) and three with deep orbital varices (Figure 5) were typically presented in their second to third decade of life with variable proptosis dependent on a change in downward head position (e.g during paryer) or on coughing. At rest, the affected eye looks relatively enophthalmic and pain free, but during period of extreme engorgement (iª²e with straining, bending forward or Valsalva¬ðs maneuver), the pain, proptosis and segmental dilatation of veins were apparent. For the most part, distensible venous lesions are not of serious consequence and do not require any intervention. The indications for surgical treatment are usually related to pain, cosmesis, or progressive expansion. The direct surgical treatment of distensible venous malformations of the orbit is difficult due to the tortuous tangles of fragile, thinª²walled, malformed vessels and their tendency to rupture and bleed excessively. Therefore, all these four patients were referred to department of vascular surgery where excision of abnormal vessels was done after isolation, ligation, clipping and thromboª²embolization.

¡¡¡¡Figure 5  Deep orbital varix £¨ÂÔ£©

¡¡¡¡A: 25 years old male with right eye deep orbital varix at resting position; B: The same patient with Valsalva's maneuver showing classical finding of increasing proptosis

¡¡¡¡Figure 6  Optic nerve glioma£¨ÂÔ£©

¡¡¡¡A: Six years old boy with left eye axial proptosis; B: Photograph of same patient showing multiple caf¨¦ª²auª²lait spots of varying sizes on the back and buttock; C: Photograph of same patient showing orbital cellulitis just after the lateral orbitotomy. The excised mass biopsy shows optic nerve glioma

ÉÏÒ»Ò³  [1] [2] [3] [4] ÏÂÒ»Ò³