Antero-medial orbital masses associated with nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) involves the orbits through direct extension to the orbital apex via the cavernous sinus. Anterior orbital masses are very rare with only a few anecdotes in the literature about an anterior spread via nasal cavity or tumour arising de novo from the lacrimal sac. Reactive lymphoid hyperplasia in the orbit has never been reported in association with NPC.

Three cases that presented with antero-medial orbital mass in association with NPC are described. Two of the three cases including one with bilateral orbital mass, had biopsy proven NPC in the orbit and presented with tearing due to lacrimal sac involvement with a palpable mass in the anteromedial orbit. The third case presented with a left antero-medial orbital mass, which on biopsy proved to be a reactive lymphoid hyperplasia. He was detected to have NPC while investigating the orbital mass. All had raised serum levels of IgA against Epstein-Barr virus (EBV).

The possible mode of spread in our case with bilateral involvement is most likely to be a metastasis, though a microscopic anterior spread through the nasal cavity and nasolacrimal duct could not be ruled out despite there being no evidence of tumour in the original site or nasal cavity. In the second case, the tumour spread from the nasal cavity into the orbit is clearly via the nasolacrimal duct. The third patient presents an interesting association of lymphoproliferative disorder and NPC with Epstein-Barr virus infection.

Anterior orbital masses involving nasolacrimal duct and lacrimal sac are rare in NPC, but can occur. A rare association of a reactive lymphoid hyperplasia in the orbit with NPC is described.