Prospective evaluation of fundus changes in patients with orbital mass lesions

To study fundus changes associated with orbital mass lesions.

In a prospective, interventional case series, 28 patients undergoing surgery for discrete orbital masses had detailed fundus examination under dilation using direct and indirect ophthalmoscopy. Preoperative visual acuity and the amount and duration of proptosis were noted. Fundus photographs were taken, and postoperative changes were documented. The main outcome measures were the frequency of various fundus changes and their correlation with other clinical features.

Nineteen (68%) of 28 patients had fundus changes; the commonest change was optic disk edema, seen in 14 patients (50%). The mean amount of proptosis +/- SD was 7.7 +/- 7.1 mm for patients with fundus changes and 4.22 +/- 2.1 mm for patients with normal fundus. Of 19 patients with fundus changes, 12 (63%) had an intraconal mass, and 11 (58%) had globe indentation. Twenty patients (71%) had diminished visual acuity preoperatively; of these patients, 8 (40%) had improvement in vision after surgery, 10 (50%) did not have any change in vision, and 2 (10%) had a postoperative decrease in visual acuity. Five (62%) of 8 patients with postoperative improvement in visual acuity had proptosis for < 2 years before surgery was undertaken, while only 1 (10%) of 10 patients retaining their preoperative vision had a duration of proptosis of < 2 years.

Fundus changes are frequently seen with orbital masses. An increased amount of proptosis, intraconal location, and globe indentation are associated with fundus changes. Postoperative improvement in visual acuity is less likely in patients with a longer duration of symptoms.