Clinical characteristics of 59 orbital space-occupying lesions: A retrospective case series

This study aims to describe the clinical spectrum, imaging localization, surgical approaches, and histopathology of orbital space-occupying lesions treated at a tertiary center. A retrospective review was conducted on 59 consecutive patients with orbital masses who were treated at the Central Hospital of Wuhan, from July 2018 to January 2025. Demographics, laterality, compartmental localization using the new 5-compartment model (intraconal, extraconal, eyeball zone, optic nerve sheath, subperiosteal), management, and pathology were summarized descriptively. We found that among the 59 lesions, 48 were benign (81.36%) and 11 were malignant (18.64%). The most frequent benign lesions were cavernous venous malformation (10/59, 16.95%), dermoid cyst (8/59, 13.56%), inflammatory pseudotumor (6/59, 10.17%), and pleomorphic adenoma of the lacrimal gland (5/59, 8.47%). Lymphoma was the most common malignant lesion (8/59, 13.56%). Fifty patients underwent surgery (lateral, anterior, or medial orbitotomy, or endoscopic transnasal approach), and 9 were managed conservatively. Benign tumors rarely recur after surgical resection and have a favorable prognosis. Malignant tumors such as lymphoma are difficult to be radically resected through surgery, requiring postoperative adjuvant radiotherapy and chemotherapy, with a high risk of recurrence and metastasis. In this single-center series, benign orbital masses were predominant, with cavernous venous malformation being the most common benign entity and lymphoma the leading malignancy. Compartment-based imaging analysis is beneficial for differential diagnosis and surgical planning; infiltrative patterns in lymphoma often preclude complete resection and necessitate adjuvant therapy.