Long-term follow-up and prognosis of orbital apex syndrome resulting from nasopharyngeal rhabdomyosarcoma.
OBJECTIVE
Nasopharyngeal rhabdomyosarcoma may present with a variety of ophthalmic symptoms. Direct extension of the tumor into the orbital apex can lead to ophthalmoplegia and loss of vision. The prognosis for recovery of vision and ocular motility in patients with an orbital apex syndrome due to nasopharyngeal rhabdomyosarcoma is examined.


METHODS
Retrospective case series.


METHODS
Six eyes from four patients with nasopharyngeal rhabdomyosarcoma who presented to the Children';s Hospital of Philadelphia with a clinical orbital apex syndrome were identified. Complete ophthalmic examination, including visual acuity and extraocular motility at the time of presentation, was reviewed. Tumor extension into the orbital apex was confirmed radiographically. Follow-up ophthalmic evaluations were reviewed for all patients with an average follow-up of 5.5 +/- 3.1 years (range 1 to 8 years).


RESULTS
Six eyes of four patients had limited ocular ductions along with marked loss of vision at presentation. All patients were treated with chemotherapy and radiation, with reduction of tumor mass. Ocular motility recovered in all patients, occurring by an average of 2.2 +/- 1.8 months after initiation of therapy. Four of six eyes had little or no recovery of visual acuity detected at long-term follow-up.


CONCLUSIONS
Patients with ocular motor deficits in orbital apex syndromes caused by extension of nasopharyngeal rhabdomyosarcoma have an excellent prognosis for recovery after treatment of the tumor. The long-term prognosis for visual recovery, however, is poor.
Shindler
Kenneth S
KS
Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia 19104, USA. Kenneth.shindler@uphs.upenn.edu
Liu
Grant T
GT
Womer
Richard B
RB
D002675:Child, Preschool; D003131:Combined Modality Therapy; D005133:Eye Movements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000473:pathology* / Q000628:therapy; D009361:Neoplasm Invasiveness; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000503:physiopathology; D009918:Orbital Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000473:pathology* / Q000628:therapy; D013577:Syndrome; D014786:Vision Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014792:Visual Acuity