CARCINOMA of the orbit is always sec ondary to similar disease of the lacrymal gland, lids, conjunctiva, eyeball, or ad joining cavities or more distant organs.
Case of tumor of the orbit, thought possibly to be syphilitic, treated with heroic doses of potassium iodide and mercury, without avail. Growth was re moved piecemeal, leaving an apparently sound eye. Panophthalmitis set in and the patient was discharged six weeks after the operation, with a sunken and sightless eyeball. Tumor removed was believed to be a sarcoma, but patient died about a year later from carcinoma of the throat. David Webster (Med. News, Aug. 27, '98).
Treatment. — Non-malignant tumors should be excised. In rare cases a der moid cyst may extend so deeply that its complete removal by dissection would be extremely difficult or impossible. In such a case we should cleanse the remain ing portion of the sac, and place in it tincture of iodine or crystals of silver nitrate to secure its obliteration. Where possible, benign tumors, even those of the optic nerve, should be removed with out sacrificing the eyeball.
For malignant tumors the only hope for cure is by complete removal. In rare cases, where the eye retains useful sight, removal of the evident new growth must be depended on. But the prospect of future immunity is decidedly improved by the removal of the whole contents of the orbit. Sarcomas of the spindle-cell variety may not return. Other varieties are more likely to recur, and it is doubt ful if removal often prolongs life. It is, however, fully justified for the pur pose of relieving pain and rendering the patient's condition temporarily more bearable.
Following conclusions are based upon histories of 36 eases of orbital tumors. all taken from personal private practice. All these cases have been watched from start to finish. In a much larger experi ence. extending over a period of twenty five years of hospital service, the same conclusions have been reached:— I The prognosis of all forms of malig nant orbital tumors, primary or secondary, is unfavorable; and, if the tumor is primarily in one or more of the deep facial bones or their sinuses, the prognosis is positively bad.
2. Except in the case of capsulated tumors of the orbit, surgical interference is almost invariably followed by a re turn of the tumor: and the growth of the secondary tumor is more rapid than that of the primary lesion. With each succeeding operation the period of quies cence in the return of the tumor grows shorter and the rapidity of the growth increases.
3. The patient's family, and in certain eases the patient himself, should, in the beginning. be told of the serious nature
of the trouble, and be warned that com plete removal of all disease-germs is a well-nigh hopeless task. The burden of the decision as to surgical interference must rest upon the shoulders of the pa tient.
4. Repeated operations in these eases undoubtedly shorten the life of the pa tient. While it is, therefore, our duty to operate in all eases in order to relieve severe or unbearable pain, we should be slow to operate merely for the sake of relieving temporarily physical disfigure ment or deformity, especially if we are convinced that by so doing we shorten the life of the patient, even if that shortened life is rendered more bearable to him. C. S. Bull (N. Y. Med. Jour., Aug. 29, '96).
Operative procedure which possesses distinct advantages over Kriinlein's original method. About the edge of the hair. in the pre-auricular and temporal region. a vertical cut is made, five centi metres from the external border of the orbit, and four to five centimetres in length. From the upper end of this a horizontal incision is carried toward the upper outer angle of the orbit, and curving slightly upward in the direction of the eyebrow in whien it terminates. Another incision parallel to this follows exactly the zygomatic arch and ends at the lower outer angle of the orbit. The skin included between these three in cisions is dissected up, exposing- the Miscellaneous Orbital Diseases.
Diseases originating in the orbital walls and neighboiing cavities include a large proportion of the cases of orbital disease. The majority of malignant tumors grow into the orbit from adjoin ing cavities. Mucocele and empyema of the frontal, ethmoidal, or maxillary sinus makes its way into the orbit, some times through an opening caused by ab temporal aponeurosis and the upper edge of the zygoma. All bleeding is arrested, and the remainder of the operation fol low; precisely the directions given by Kri;nlein.
The incisions give the surgeon much more room during the operation; they are far enough from the conjunctival sae to exerude any risk of infection from it: and the cicatrices are scarcely noticeable, being largely hidden by the hair. Parinaml and Roche (Annales d*Oculist., Oct., 1901).
sorption of the bony wall, sometimes pushing a bony shell before it. The most important treatment is that di rected against the original disease. This, with free drainage, will generally secure the healing of the lesions in the orbit.