Ocular surface squamous neoplasia with orbital tumour extension: risk factors and outcomes.

PURPOSE: To describe the risk factors, clinical features, histopathology, treatment, and outcomes of patients with orbital tumour extension of ocular surface squamous neoplasia (OSSN). METHODS: Retrospective study of 51 patients with orbital tumour extension (cases) and 360 patients without orbital extension (controls). RESULTS: Of 1,653 patients with OSSN, orbital tumour extension was noted in 51 (3%) cases. The risk factors for orbital tumour extension included outdoor occupation (p < 0.03; Odds ratio (OR) = 1.96), Human Immunodeficiency Virus (HIV) infection (p < 0.0001; OR = 5.81), prolonged duration of symptoms (p = 0.01; OR = 1.02), tumour bilaterality (p = 0.02; OR = 2.92), forniceal and tarsal conjunctival involvement, diffuse tumour (p < 0.0001; OR = 9.13), inferior quadrantic location (p < 0.0001; OR = 7.51), increased tumour thickness (p = 0.04; OR = 1.59), higher % of ocular surface involvement (p = 0.002; OR = 1.12), nodular (p = 0.002; OR = 2.61) and nodulo-ulcerative (p < 0.0001; OR = 11.05) tumour morphology, poorly differentiated tumours (p = 0.006; OR = 4.23); invasive squamous cell carcinoma (SCC) (p < 0.0001; OR = 29.76), spindle cell and mucoepidermoid variant (p = 0.02; OR = 16.94) tumours. At a mean follow-up period of 27 months, tumour recurrence in the socket was noted in 1 (2%), locoregional lymph node metastasis (LNM) in 15 (29%) patients, and nine (18%) patients died due to systemic metastasis (SM). T4 tumour at presentation was a risk factor for LNM (p = 0.01; Hazard ratio (HR) = 5.60) and SM (p = 0.0003; HR = 5.09). CONCLUSION: Orbital extension of OSSN is rare. Outdoor occupation, HIV infection, larger and thicker tumours in the inferior quadrant with forniceal and/or tarsal conjunctival involvement with nodular or noduloulcerative morphology, poor tumour differentiation, SCC, spindle cell and mucoepidermoid variants on histopathology are at increased risk for orbital tumour extension.

Masquerades of Acquired Dacryocystocele.

INTRODUCTION: Dacryocystocele can be congenital or acquired and acute or chronic, based on underlying pathology. An inferomedial anterior orbital mass lesion can masquerade an acquired dacryocystocele with similar symptomatology; however, the treatment varies. Hence, a careful examination of the swelling to differentiate these masquerades is needed to ensure rightful treatment. PATIENTS AND METHODS: A retrospective, interventional study was performed on consecutive patients from January 2017 to October 2019 who presented with swelling in the lacrimal sac area of varying durations. They underwent computed tomography scans followed by surgical intervention. Their relation to the lacrimal drainage apparatus was explored. RESULTS: During the study period, 5 such patients were found in the records. The radiology was consistent with anterior orbital mass lesions, not involving the lacrimal sac. Histopathology after surgical excision was consistent with three of the lesions being dermoid cysts, one was cavernous hemangioma and one was a solitary fibrous tumor. CONCLUSION: Inferomedial anterior orbital mass lesions can present as masquerades of acquired dacrycystoceles. Careful examination and high degree of suspicion is needed to distinguish these lesions and ensure correct treatment.