Zusammenfassung
Leitsymptom einer orbitalen Raumforderung ist der Exophthalmus. Weitere Zeichen sind Veränderungen der okulären Adnexe wie Lidschwellung, Motilitätseinschränkung, ein durch eine Optikuskompression auftretendes relatives afferentes Pupillendefizit oder eine kompressionsbedingte Papillenveränderung wie Schwellung oder Atrophie. Orbitatumoren lassen sich ätiologisch verschiedenen Kategorien zuordnen: Lymphoproliferative Tumoren, insbesondere das Non-Hodgkin-Lymphom, sind die häufigsten malignen Orbitatumoren des Erwachsenen. Etwa gleich häufig treten Tumoren des Sehnerven und seiner Meningen, Tumoren der Tränendrüse, sekundäre Tumoren, die aus benachbarten Strukturen infiltrieren, und Metastasen auf. Es folgen vaskuläre und zystische Tumoren: Das kavernöse Hämangiom ist der häufigste benigne Tumor des Erwachsenen, die Dermoidzyste der häufigste benigne Tumor des Kindes. Das Rhabdomyosarkom als häufigster maligner Orbitatumor des Kindes ist relativ betrachtet selten. Orbitatumoren verursachen nicht nur Symptome wie Schmerzen, Diplopie und Visusverlust, sondern können auch zu ästhetisch belastenden Veränderungen führen. Als Ursache müssen insbesondere Systemerkrankungen und generalisierte Tumorerkrankungen ausgeschlossen werden. Daher ist eine genaue klinische und radiologische Diagnostik unerlässlich. In diesem Beitrag werden die klinische und radiologische Vorgehensweise erläutert.
Abstract
Exophthalmus is the leading sign of space-occupying lesions of the orbit. Patients may further present with lid swelling, impaired ocular motility and optic neuropathy including a relative afferent pupillary defect, compressive optic disc edema or optic atrophy. Orbital tumors can be classified into various categories depending on the etiology, as lymphoproliferative lesions (in particular Non-Hodgkin’s lymphoma as the most common malignant orbital tumor of adulthood), optic nerve and meningeal lesions, lacrimal gland lesions, secondary orbital tumors which extend to the orbit from neighboring structures and metastases. Slightly less common are vasculogenic and cystic lesions including cavernous hemangioma as the most common benign orbital tumor of adulthood and dermoid cysts as the most common benign orbital tumor of childhood. Rhabdomyosarcoma is the most common malignant orbital tumor of childhood but has a low total incidence. Orbital tumors might not only cause symptoms like pain, diplopia and loss of visual acuity but may also lead to esthetically disfiguring changes. Particular attention should be paid to underlying systemic diseases and generalized tumor diseases. This article illustrates the approach to a detailed clinical and neuroradiological assessment which is mandatory for the care of orbital tumor patients.
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Poloschek, C., Lagrèze, W., Ridder, G. et al. Klinische und neuroradiologische Diagnostik bei Orbitatumoren. Ophthalmologe 108, 510–518 (2011). https://doi.org/10.1007/s00347-010-2190-z
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DOI: https://doi.org/10.1007/s00347-010-2190-z