Systemic diseases, primary orbital diseases and extraorbital lesions extending into the orbit may lead to ocular proptosis. Eleven patients with ocular proptosis caused by non previously treated extraorbital malignant tumors were studied with computed tomography. Nonepithelial neoplasms were the most common tumors (82%) including three rabdomyosarcomas (27%), three non-Hodgkin's lymphomas (27%), and other sarcomas in two patients (18%). Squamous cell carcinoma (9%), Burkitt's lymphoma (9%) and poorly differentiated carcinoma (9%) were also identified. The most common primary sites of the tumors were the sinonasal cavities (nine cases; 82%), particularly the ethmoidal sinus (five cases). Ocular proptosis was the only ophthalmic sign in four patients (36%) whereas one patient had bilateral ocular proptosis as the only sign of disease. Seventeen orbits were involved due to six patients had bilateral tumor extension into the orbits. Tumor extension into the orbits was mainly through the orbital bone (16 orbits; 94%). There was involvement of all compartments in most of the orbits (59%). The tumor was extraconal in 16 orbits. Computed tomography revealed ocular proptosis in 15 of the 17 orbits (88%), which was bilateral in four cases (eight orbits). Grade 2 ocular proptosis was observed in seven patients (47%). Forty-four regions of the face and skull were involved, excluding the orbits and the primary site of the tumor, indicating extensive loco-regional disease at the time of the diagnosis.

Keywords: Ocular proptosis, Malignant tumors, Orbital extension

Malignant tumors of the sinonasal cavities are rare and often diagnosed late in the course of the disease. These tumors can extend into regions such as the orbit and brain, where treatment is difficult. Ten patients with nontreated sinonasal malignant neoplasms and radiological evidence of tumor extension into the orbit and brain were studied with computed tomography. Five (50%) tumors were epithelial neoplasms whereas squamous cell carcinoma was the most common type (3 cases). The ethmoidal sinus was the most common site of origin of the tumors (40%), followed by the maxillary sinus (30%) and nasal cavity (30%). A total of 16 orbits were involved since 6 patients (60%) had bilateral orbital involvement. The tumors extended more often into the orbits through erosion of the medial and inferior orbital bones. All orbital compartments were involved in the majority of the orbits. Tumoral extension into the cranial cavity was more common through the ethmoidal (70%) and orbital roof (30%). The anterior cranial fossa was involved in 8 cases (80%), followed by the medial cranial fossa (40%) and frontal lobe (excluding the anterior fossa) (30%). Thirty-seven regions of the face, other that the site of tumor origin, orbits and cranial cavity, were involved by the 10 tumors, indicating the extensive loco-regional disease at the time of diagnosis.

Keywords: Sinonasal malignant tumors, Orbital invasion, Cranial invasion, Computed tomography