Incidence of benign vascular tumors in the orbit and ocular adnexa in an ophthalmological hospital in Mexico

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Fonseca-Aguirre, Paulina D. Araujo-Martinez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6200593/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This retrospective study aimed to analyze the incidence of benign vascular tumors in the orbit and ocular adnexa at an ophthalmological hospital over a five-year period and to describe their demographic and clinical characteristics. Materials and Methods The medical records of patients with vascular tumors in the orbit or ocular adnexa who underwent histopathological studies between 2017 and 2021 were retrospectively reviewed. Results A total of 30 cases were included. The average age was 40.9 years, and 16 patients (53.3%) were female. Capillary hemangioma was the most prevalent vascular tumor, accounting for 60% of cases, with a mean age of 44 years; 55.5% of these cases were women. Cavernous hemangioma was observed in 23.3% of the patients, with a mean age of 50 years; 71.4% of these patients were women. Lymphangioma was present in 20% of the patients, with an average age of 22 years; 40% of these patients were women. The highest frequency of cases was found in the seventh decade of life, accounting for 20% of the total cases. The third, fifth, and ninth decades presented the lowest frequency, with one case (3.3%) in each. Discussion This study revealed two significant age peaks in the manifestation of benign vascular tumors. The first peak was prominently observed during the first two decades of life. The second peak occurred in the seventh decade, with a higher incidence among women. Capillary hemangioma has emerged as the most prevalent benign vascular tumor, demonstrating its dominance across all age groups, from childhood through adulthood. Benign Vascular Tumors Orbit Figures Figure 1 INTRODUCTION Orbital neoplasms are rare clinical entities, accounting for approximately 1% of the patient population in ophthalmology clinics. Despite their low incidence, they have significant clinical impact, with a higher prevalence associated with aging. ( 1 ) In a groundbreaking investigation, Shields et al. ( 2 ), in 1989, examined 645 biopsies of orbital tumors and reported that 6% of these corresponded to vascular tumors. In an extensive study conducted by Henderson et al. ( 3 ) at the Mayo Clinic from 1988–1997, the five most prevalent types of primary tumors in the orbit were carcinomas, hematopoietic, vascular, inflammatory, and cystic. Within the classification of benign vascular tumors, the most common include capillary hemangioma, cavernous hemangioma, lymphangioma, and hemangiopericytoma. ( 4 , 5 ) This retrospective study aims to analyze the incidence of benign vascular tumors in the orbit and eyes. This study aimed to provide a comprehensive description of the demographic and clinical data associated with these tumors. Capillary hemangioma Capillary hemangioma is the most prevalent benign vascular tumor in the orbit of pediatric patients, constituting between 8% and 10% of benign tumors in this age group, 80% of which are located in the head and neck region. ( 6 ) A predilection for females is shown, with a female-to-male ratio ranging from 3:2 to 5:1. ( 7 ) These hemangiomas are usually of congenital origin and increase in volume during the first 6–12 months, followed by an involution phase that begins after the first year of life; approximately 75% of the lesions resolve before age 7. Associated factors include female sex, low birth weight, prematurity, and maternal chorionic villus biopsy. Clinical manifestations can vary, with superficial capillary hemangiomas affecting the skin presenting as bright red soft masses with a characteristic dimpled texture, whereas subcutaneous hemangiomas may acquire a bluish hue. Deeper hemangiomas in the orbit can manifest as masses progressively increasing in size without apparent skin changes. In the periocular area, these hemangiomas tend to be more frequently located in the orbit's superonasal quadrant and the upper eyelid's medial portion. Additionally, their association with hemangiomas in other body regions has been reported. ( 1 , 9 , 10 ). Cavernous hemangioma Cavernous hemangioma is the most common benign vascular neoplasm of the adult orbit and affects women twice as often as men do. The intraconal space is the most affected site. There is an unexplained predisposition for left-sided localization. The cause is likely congenital venous vascular malformation, which is initially asymptomatic. During disease, ectatic expansion, partial thrombosis, and calcification occur until the first symptoms typically appear between the fifth and seventh decades of life. The clinical picture consists of axial and painless proptosis, often associated with folds in the retina and choroid with a decrease in axial length. Compression of the optic nerve is quite rare and should be considered a late sign; diplopia-generating motility disorders are also rare. Puberty or pregnancy can lead to rapid development of proptosis, suggesting the involvement of a hormone- or cytokine-mediated angiogenic factor. They are almost entirely isolated from orbital blood circulation, making them prone to thrombosis, and their study by angiography is complex. The rupture of cavernous hemangioma is a known but infrequent cause of nontraumatic orbital hemorrhage. Clinically, it is characterized by painful proptosis, diplopia, and visual field impairment. ( 1 , 11 – 13 ). Lymphangiomas Lymphangiomas, classified as vascular hamartomas, manifest as lymphatic vascular structures that typically develop from pluripotent venous vascular systems. Although they may be present at birth, their prevalence is notable in childhood and adolescence, with 43% of lesions becoming evident before age 6. Clinically, they are characterized by painless and progressive proptosis, with alterations in eye movements, rarely inducing diplopia. In some cases, spontaneous bleeding or mild trauma can trigger an acute clinical picture, posing a threat to vision. Additionally, viral infections can induce transient volume increases due to lymphocytic proliferation, which resolve spontaneously after infection remission. ( 1 , 10 ) Infiltrative growth often hinders a curative approach through complete excision, favoring a surveillance strategy. However, in situations where complications threaten vision, such as progressive proptosis or acute hemorrhages, volume reduction procedures are considered. The prognosis varies on the basis of the individual growth rate and extent of infiltration into orbital soft tissues. ( 1 , 14 ). Hemangiopericytomas Hemangiopericytomas are rare mesenchymal pericytic tumors that predominantly occur in skeletal muscle, the pelvis, and the retroperitoneum. Approximately 15% of cases present extracranially, including exceptional occurrences in the orbit. Clinically, these tumors can arise at any age, although they typically manifest in the fourth decade of life. Symptomatology encompasses findings associated with an expansive orbital mass, depending on the location within the orbit, with a preference for the extraconal space, often in proximity to the paranasal sinuses. ( 1 , 15 ) Histological analysis reveals a broad spectrum of characteristics, ranging from benign to malignant, although rare metastases occur in approximately 15% of cases. Therefore, complete surgical excision is recommended as the primary treatment, and additional radiotherapy is advised in cases of incomplete removal. Despite these approaches, the local recurrence rate reaches 30%, with cases of late recurrence reported up to 30 years after initial treatment. ( 16 ) MATERIALS AND METHODS A retrospective, descriptive, cross-sectional, and observational study was conducted at Hospital Nuestra Señora de la Luz in Mexico City. The inclusion criteria included patients who were diagnosed with benign vascular tumors of the orbit or ocular adnexa through histopathological studies between January 2017 and December 2021 in the Department of Orbit and Oculoplastics. This study adhered to the Health Insurance Portability and Accountability Act of 1996 and followed the principles outlined in the Declaration of Helsinki. All participants provided informed consent prior to their inclusion in the study. The study protocol was approved by the Ethics Committee of the Hospital Fundación Nuestra Señora de la Luz. A comprehensive review of medical records for patients with the aforementioned diagnoses was conducted. A database was created via Microsoft Excel to systematically organize the collected data. The analyzed parameters included demographic information, duration of symptoms, reason for consultation, affected side, diagnostic impressions, histopathological diagnosis, symptoms (visual, oculomotor, compressive, and extraorbital), and the therapeutic approach administered to these patients. RESULTS Out of a total of 30 cases, 53.3% (16 cases) occurred in women, and 46.6% (14 cases) occurred in men, with a mean age of 40.9 years (range: 3–85 years). The distribution by age decades revealed the highest frequency in the seventh decade of life (20%), followed by the first, second, and sixth decades (16.6% each). The third, fifth, and ninth decades presented the lowest frequency, with 3.3% of cases each (Fig. 1 ). With respect to laterality, 56.6% (17 patients) involved the right side, whereas 43.3% (13 patients) involved the left side. The most common location was the upper eyelid (36.6%), whereas the extraconal space, caruncle, and tarsal conjunctiva had the lowest frequency (3.3% each) (Table 1 ). The most frequent reason for consultation was the presence of painless swelling (60%), whereas ocular pain, painful swelling, itching, and chemosis were the least common, each accounting for 3.3% of cases (Table 2 ). Symptoms were categorized into four groups: visual, oculomotor, compressive, and extraorbital. Extraorbital symptoms were the most prevalent (60%), followed by compressive symptoms (26.6%). Oculomotor and visual symptoms were less common, each accounting for 13.3% of the cases (Table 3 ). During the ophthalmological examination, the preliminary diagnostic impression prior to histopathological study was capillary hemangioma in 43.3% of the patients. However, the histopathological study revealed capillary hemangioma in 56.6% of the patients, cavernous hemangioma in 20%, lymphangioma in 20%, and concurrent capillary and cavernous hemangioma in 3.3% of the patients (Table 4 ). The diagnostic accuracy was 64.7% for capillary hemangioma, 28.5% for cavernous hemangioma, and 83.3% for lymphangioma. The therapeutic approaches are summarized in Table 5. Table 1 Tumor location Total Upper eyelid 11 Lower eyelid 7 Intraconal 4 Bulbar conjunctiva 2 Periorbital skin 2 Extraconal 1 Eyebrow area 1 Caruncle 1 Tarsal conjunctiva 1 Table 2 Reason for consultation Total Painless tumor 18 Unilateral proptosis 4 Foreign body sensation 3 Ocular pain 1 Painful tumor 1 Itching 1 Hyperemia 1 Chemosis 1 Table 3 Clinical presentations Visual alterations Total Diplopia 2 Color perception alterations 1 Reduced visual acuity 1 Oculomotor abnormalities Total Restriction of eye movements 3 Exotropia 1 Compressive alterations Total Proptosis 4 Pain 3 Conjunctival hyperemia 1 Extraorbital alterations Total Foreign body sensation 5 Prurito 3 Eyelid edema 2 Occasional bleeding 2 Painless chemosis 2 Tearing 1 Mechanical ptosis 1 Epiphora 1 Hemolacria 1 Table 4 Diagnosis Clinical diagnosis Total Capillary hemangioma 13 Lymphangioma 5 Hidrocystoma 3 Pyogenic granuloma 2 Cavernous hemangioma 2 Hemangiolymphangioma 1 Unspecified Hemangioma 1 Dermolipoma 1 Lipoma 1 Basal cell carcinoma 1 Primary pterygium 1 Histopathological diagnosis Total Capillary hemangioma 17 Cavernous hemangioma 6 Lymphangioma 6 Capillary and cavernous hemangioma 1 Table 5. Therapeutic approach Total Simple resection 23 Resection and Bleomycin 3 Orbitotomy 3 Observation 1 Correlation with Clinical Findings Capillary hemangioma was the vascular tumor with the highest prevalence, with 17 cases (56.6%) and one case of concomitant capillary and cavernous hemangioma (3.3%). The mean age at presentation was 44 years, with the seventh decade of life having the highest number of cases (4 cases). There were 10 cases in women (55.5%) and 8 in men (44.4%). Right-sided involvement was observed in 10 patients (55.5%), and left-sided involvement was observed in 8 patients (44.4%). The primary location was the upper eyelid in 10 patients (55.5%) and, less frequently, in the ciliary region, intraconal space, and caruncle in 1 patient (5.5% each). The main reason for consultation was the presence of painless swelling in 13 patients (72.2%), with pruritus and unilateral proptosis being less common, each in 1 patient (5.5% each). The most common duration of evolution was one year in 7 patients and 1 to 5 years in 7 patients (38.8% each). Extraorbital alterations were the most common, with 8 cases, including the sensation of a foreign body, which was the most common. Other manifestations included pruritus, tumor bleeding, and mechanical ptosis. Only one patient presented with oculomotor restriction, and another patient presented with unilateral proptosis. The ophthalmological examination revealed that 11 patients (61.1%) were correctly diagnosed. All patients were managed with simple resection. Cavernous hemangioma was the second most prevalent vascular tumor, with 6 cases (20%), and one case of concomitant capillary and cavernous hemangioma (3.3%). The mean age at presentation was 50 years, with the fourth and seventh decades having the highest number of cases (2 cases each). There were 5 cases in women (71.4%) and 2 in men (28.5%). Right-sided involvement was observed in 4 patients (57.1%), and left-sided involvement was observed in 3 patients (42.8%). The primary location was the lower eyelid, with 2 cases (28.5%). The main reason for consultation was the presence of painless swelling in 4 patients (57.1%), whereas ocular pain and chemosis were less common, occurring in 2 and 1 patients, respectively. The most common duration of evolution was less than one year in 2 patients, 1 to 5 years in 2 patients, and 6 to 10 years in 2 patients. Extraorbital alterations were the most common, with 3 cases, including the sensation of a foreign body, chemosis, and hemolacria, each in one case. Other alterations included diplopia, exotropia, and oculomotor restriction, each in one patient. The clinical findings from the ophthalmological examination correctly revealed 2 cases (28.5%). Therapeutic management included simple resection in 4 patients (57.1%), orbitotomy in 2 patients (28.5%), and surveillance in only one patient. Lymphangioma was the third most prevalent vascular tumor, with 6 cases (20%). The mean age at presentation was 22 years, with the second decade having the highest number of cases (2 cases). There were 2 cases in women (40%) and 3 in men (60%). Right-sided involvement was observed in 3 patients (60%), and left-sided involvement was observed in 2 patients (40%). The primary location was in the intraconal space, with 2 cases (40%). The main reason for consultation was the presence of unilateral proptosis in 3 patients (60%), whereas painless swelling and hyperemia were less common, each in 1 patient (20% each). The most common duration of evolution was 6–10 years in 3 patients (60%). Compressive alterations were the most common, with 4 cases, including unilateral proptosis, which was the most common alteration in 3 cases, and eyelid edema, which was the most common alteration in 2 cases. Other alterations included oculomotor restriction, pain, hyperemia, epiphora, and the sensation of a foreign body. Diagnostic accuracy on the basis of the clinical findings of the ophthalmological examination was not achieved. Therapeutic management included resection with bleomycin in 3 patients (60%), orbitotomy in 1 patient (20%), and simple resection in 1 patient (20%). An exceptional case of arteriovenous malformation was recorded in the right upper eyelid of a 54-year-old patient, with painless swelling for 10 years. The preliminary diagnostic impression was a capillary hemangioma, and the management consisted of simple resection. DISCUSSION Vascular tumors of the orbit and its adnexa represent a topic of utmost importance in the daily practice of ophthalmologists. These tumors can occur at any age, within the seventh decade of life, as found in this series, with the age with the highest prevalence. The vascular tumor that occurred most frequently was capillary hemangioma. It is reported in the literature to be the most prevalent in childhood and is more common in female patients ( 6 , 7 , 17 , 18 ). In our series, capillary hemangioma accounted for 33% of cases in the first two decades of life. Although it predominates in patients over 50 years of age, it remains the tumor with the highest incidence in the pediatric stage, which is consistent with the literature. Therapeutic management in the literature is recommended to be conservative, reserving surgical intervention for cases where vision is compromised or when complete resection can be guaranteed, such as in cases involving the eyelid ( 8 ). In our study, 100% of capillary hemangiomas were managed with simple resection. One of the differential diagnoses to consider is arteriovenous malformation, as observed in our study. Cavernous hemangioma is the most common primary vascular tumor in adults and is more common in female patients ( 1 ). The findings in our series correspond to those reported in the literature. Although a predilection for the left side has also been reported, in our series, the prevalence was slightly higher on the right side, differing by just one case. Therapeutic management depends on the symptoms or adjacent damage that may occur; different surgical approaches can be performed depending on the location, or surveillance can be considered, as presented in the cases in our series ( 13 ). Lymphangioma typically manifests in the first two decades of life, as found in our series. It is often associated with slowly progressive painless proptosis accompanied by oculomotor restriction without diplopia. In cases of tumors with infiltrative growth, complete excision is often impossible, leading to a surveillance strategy. Surgical intervention is indicated in cases of complications that threaten vision, such as progressive exophthalmos or acute bleeding. Alternative therapies have also been described, including intralesional injection of sclerosing agents or steroids, fractionated radiation, or CO2 laser ablation ( 1 , 10 ). All the lymphangiomas were managed surgically in our series, with three cases complemented with bleomycin as a sclerosing agent. Our study has several limitations, as it was a retrospective analysis and had a small sample size due to the nature of the studied pathology. The strengths of the study include a comprehensive description of demographic, clinical, and histopathological aspects. Declarations Conflict of interest statement The authors have declared that no competing interests exist. Author Contribution All authors contributed to the study conception and design. Material preparation and data collection were performed by GUFA. Analysis was performed by PDAM. The first draft of the manuscript was written by PDAM and GUFA commented on previous versions of the manuscript. 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Despite their low incidence, they have significant clinical impact, with a higher prevalence associated with aging. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn a groundbreaking investigation, Shields et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), in 1989, examined 645 biopsies of orbital tumors and reported that 6% of these corresponded to vascular tumors. In an extensive study conducted by Henderson et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) at the Mayo Clinic from 1988\u0026ndash;1997, the five most prevalent types of primary tumors in the orbit were carcinomas, hematopoietic, vascular, inflammatory, and cystic. Within the classification of benign vascular tumors, the most common include capillary hemangioma, cavernous hemangioma, lymphangioma, and hemangiopericytoma. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) This retrospective study aims to analyze the incidence of benign vascular tumors in the orbit and eyes. This study aimed to provide a comprehensive description of the demographic and clinical data associated with these tumors.\u003c/p\u003e\n\u003ch3\u003eCapillary hemangioma\u003c/h3\u003e\n\u003cp\u003eCapillary hemangioma is the most prevalent benign vascular tumor in the orbit of pediatric patients, constituting between 8% and 10% of benign tumors in this age group, 80% of which are located in the head and neck region. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) A predilection for females is shown, with a female-to-male ratio ranging from 3:2 to 5:1. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) These hemangiomas are usually of congenital origin and increase in volume during the first 6\u0026ndash;12 months, followed by an involution phase that begins after the first year of life; approximately 75% of the lesions resolve before age 7. Associated factors include female sex, low birth weight, prematurity, and maternal chorionic villus biopsy. Clinical manifestations can vary, with superficial capillary hemangiomas affecting the skin presenting as bright red soft masses with a characteristic dimpled texture, whereas subcutaneous hemangiomas may acquire a bluish hue. Deeper hemangiomas in the orbit can manifest as masses progressively increasing in size without apparent skin changes. In the periocular area, these hemangiomas tend to be more frequently located in the orbit's superonasal quadrant and the upper eyelid's medial portion. Additionally, their association with hemangiomas in other body regions has been reported. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCavernous hemangioma\u003c/h2\u003e \u003cp\u003eCavernous hemangioma is the most common benign vascular neoplasm of the adult orbit and affects women twice as often as men do. The intraconal space is the most affected site. There is an unexplained predisposition for left-sided localization. The cause is likely congenital venous vascular malformation, which is initially asymptomatic. During disease, ectatic expansion, partial thrombosis, and calcification occur until the first symptoms typically appear between the fifth and seventh decades of life. The clinical picture consists of axial and painless proptosis, often associated with folds in the retina and choroid with a decrease in axial length. Compression of the optic nerve is quite rare and should be considered a late sign; diplopia-generating motility disorders are also rare. Puberty or pregnancy can lead to rapid development of proptosis, suggesting the involvement of a hormone- or cytokine-mediated angiogenic factor. They are almost entirely isolated from orbital blood circulation, making them prone to thrombosis, and their study by angiography is complex. The rupture of cavernous hemangioma is a known but infrequent cause of nontraumatic orbital hemorrhage. Clinically, it is characterized by painful proptosis, diplopia, and visual field impairment. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLymphangiomas\u003c/h3\u003e\n\u003cp\u003eLymphangiomas, classified as vascular hamartomas, manifest as lymphatic vascular structures that typically develop from pluripotent venous vascular systems. Although they may be present at birth, their prevalence is notable in childhood and adolescence, with 43% of lesions becoming evident before age 6. Clinically, they are characterized by painless and progressive proptosis, with alterations in eye movements, rarely inducing diplopia. In some cases, spontaneous bleeding or mild trauma can trigger an acute clinical picture, posing a threat to vision. Additionally, viral infections can induce transient volume increases due to lymphocytic proliferation, which resolve spontaneously after infection remission. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Infiltrative growth often hinders a curative approach through complete excision, favoring a surveillance strategy. However, in situations where complications threaten vision, such as progressive proptosis or acute hemorrhages, volume reduction procedures are considered. The prognosis varies on the basis of the individual growth rate and extent of infiltration into orbital soft tissues. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eHemangiopericytomas\u003c/h3\u003e\n\u003cp\u003eHemangiopericytomas are rare mesenchymal pericytic tumors that predominantly occur in skeletal muscle, the pelvis, and the retroperitoneum. Approximately 15% of cases present extracranially, including exceptional occurrences in the orbit. Clinically, these tumors can arise at any age, although they typically manifest in the fourth decade of life. Symptomatology encompasses findings associated with an expansive orbital mass, depending on the location within the orbit, with a preference for the extraconal space, often in proximity to the paranasal sinuses. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Histological analysis reveals a broad spectrum of characteristics, ranging from benign to malignant, although rare metastases occur in approximately 15% of cases. Therefore, complete surgical excision is recommended as the primary treatment, and additional radiotherapy is advised in cases of incomplete removal. Despite these approaches, the local recurrence rate reaches 30%, with cases of late recurrence reported up to 30 years after initial treatment. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eA retrospective, descriptive, cross-sectional, and observational study was conducted at Hospital Nuestra Se\u0026ntilde;ora de la Luz in Mexico City. The inclusion criteria included patients who were diagnosed with benign vascular tumors of the orbit or ocular adnexa through histopathological studies between January 2017 and December 2021 in the Department of Orbit and Oculoplastics.\u003c/p\u003e \u003cp\u003e This study adhered to the Health Insurance Portability and Accountability Act of 1996 and followed the principles outlined in the Declaration of Helsinki. All participants provided informed consent prior to their inclusion in the study. The study protocol was approved by the Ethics Committee of the Hospital Fundaci\u0026oacute;n Nuestra Se\u0026ntilde;ora de la Luz.\u003c/p\u003e \u003cp\u003eA comprehensive review of medical records for patients with the aforementioned diagnoses was conducted. A database was created via Microsoft Excel to systematically organize the collected data. The analyzed parameters included demographic information, duration of symptoms, reason for consultation, affected side, diagnostic impressions, histopathological diagnosis, symptoms (visual, oculomotor, compressive, and extraorbital), and the therapeutic approach administered to these patients.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOut of a total of 30 cases, 53.3% (16 cases) occurred in women, and 46.6% (14 cases) occurred in men, with a mean age of 40.9 years (range: 3\u0026ndash;85 years). The distribution by age decades revealed the highest frequency in the seventh decade of life (20%), followed by the first, second, and sixth decades (16.6% each). The third, fifth, and ninth decades presented the lowest frequency, with 3.3% of cases each (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eWith respect to laterality, 56.6% (17 patients) involved the right side, whereas 43.3% (13 patients) involved the left side. The most common location was the upper eyelid (36.6%), whereas the extraconal space, caruncle, and tarsal conjunctiva had the lowest frequency (3.3% each) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe most frequent reason for consultation was the presence of painless swelling (60%), whereas ocular pain, painful swelling, itching, and chemosis were the least common, each accounting for 3.3% of cases (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Symptoms were categorized into four groups: visual, oculomotor, compressive, and extraorbital. Extraorbital symptoms were the most prevalent (60%), followed by compressive symptoms (26.6%). Oculomotor and visual symptoms were less common, each accounting for 13.3% of the cases (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eDuring the ophthalmological examination, the preliminary diagnostic impression prior to histopathological study was capillary hemangioma in 43.3% of the patients. However, the histopathological study revealed capillary hemangioma in 56.6% of the patients, cavernous hemangioma in 20%, lymphangioma in 20%, and concurrent capillary and cavernous hemangioma in 3.3% of the patients (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The diagnostic accuracy was 64.7% for capillary hemangioma, 28.5% for cavernous hemangioma, and 83.3% for lymphangioma. The therapeutic approaches are summarized in Table 5.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTumor location\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper eyelid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower eyelid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntraconal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBulbar conjunctiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePeriorbital skin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtraconal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEyebrow area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaruncle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTarsal conjunctiva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\u0026nbsp;\u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eReason for consultation\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePainless tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnilateral proptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eForeign body sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOcular pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePainful tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHyperemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChemosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical presentations\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVisual alterations\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiplopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eColor perception alterations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReduced visual acuity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOculomotor abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRestriction of eye movements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExotropia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompressive alterations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConjunctival hyperemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtraorbital alterations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eForeign body sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrurito\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEyelid edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccasional bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePainless chemosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTearing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMechanical ptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEpiphora\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemolacria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eClinical diagnosis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCapillary hemangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHidrocystoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePyogenic granuloma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCavernous hemangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemangiolymphangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnspecified Hemangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDermolipoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLipoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBasal cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary pterygium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistopathological diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCapillary hemangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCavernous hemangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCapillary and cavernous hemangioma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\" style=\"margin-right: calc(64%); width: 36%;\"\u003e\n \u003ctbody\u003e\u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;5.\u003c/strong\u003e Therapeutic approach\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 69.5502%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 30.1038%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 69.5502%;\"\u003e\n \u003cp\u003eSimple resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 30.1038%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 69.5502%;\"\u003e\n \u003cp\u003eResection and Bleomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 30.1038%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 69.5502%;\"\u003e\n \u003cp\u003eOrbitotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 30.1038%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 69.5502%;\"\u003e\n \u003cp\u003eObservation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 30.1038%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eCorrelation with Clinical Findings\u003c/h2\u003e\n \u003cp\u003eCapillary hemangioma was the vascular tumor with the highest prevalence, with 17 cases (56.6%) and one case of concomitant capillary and cavernous hemangioma (3.3%). The mean age at presentation was 44 years, with the seventh decade of life having the highest number of cases (4 cases). There were 10 cases in women (55.5%) and 8 in men (44.4%). Right-sided involvement was observed in 10 patients (55.5%), and left-sided involvement was observed in 8 patients (44.4%). The primary location was the upper eyelid in 10 patients (55.5%) and, less frequently, in the ciliary region, intraconal space, and caruncle in 1 patient (5.5% each). The main reason for consultation was the presence of painless swelling in 13 patients (72.2%), with pruritus and unilateral proptosis being less common, each in 1 patient (5.5% each). The most common duration of evolution was one year in 7 patients and 1 to 5 years in 7 patients (38.8% each). Extraorbital alterations were the most common, with 8 cases, including the sensation of a foreign body, which was the most common. Other manifestations included pruritus, tumor bleeding, and mechanical ptosis. Only one patient presented with oculomotor restriction, and another patient presented with unilateral proptosis. The ophthalmological examination revealed that 11 patients (61.1%) were correctly diagnosed. All patients were managed with simple resection.\u003c/p\u003e\n \u003cp\u003eCavernous hemangioma was the second most prevalent vascular tumor, with 6 cases (20%), and one case of concomitant capillary and cavernous hemangioma (3.3%). The mean age at presentation was 50 years, with the fourth and seventh decades having the highest number of cases (2 cases each). There were 5 cases in women (71.4%) and 2 in men (28.5%). Right-sided involvement was observed in 4 patients (57.1%), and left-sided involvement was observed in 3 patients (42.8%). The primary location was the lower eyelid, with 2 cases (28.5%). The main reason for consultation was the presence of painless swelling in 4 patients (57.1%), whereas ocular pain and chemosis were less common, occurring in 2 and 1 patients, respectively. The most common duration of evolution was less than one year in 2 patients, 1 to 5 years in 2 patients, and 6 to 10 years in 2 patients. Extraorbital alterations were the most common, with 3 cases, including the sensation of a foreign body, chemosis, and hemolacria, each in one case. Other alterations included diplopia, exotropia, and oculomotor restriction, each in one patient. The clinical findings from the ophthalmological examination correctly revealed 2 cases (28.5%). Therapeutic management included simple resection in 4 patients (57.1%), orbitotomy in 2 patients (28.5%), and surveillance in only one patient.\u003c/p\u003e\n \u003cp\u003eLymphangioma was the third most prevalent vascular tumor, with 6 cases (20%). The mean age at presentation was 22 years, with the second decade having the highest number of cases (2 cases). There were 2 cases in women (40%) and 3 in men (60%). Right-sided involvement was observed in 3 patients (60%), and left-sided involvement was observed in 2 patients (40%). The primary location was in the intraconal space, with 2 cases (40%). The main reason for consultation was the presence of unilateral proptosis in 3 patients (60%), whereas painless swelling and hyperemia were less common, each in 1 patient (20% each). The most common duration of evolution was 6\u0026ndash;10 years in 3 patients (60%). Compressive alterations were the most common, with 4 cases, including unilateral proptosis, which was the most common alteration in 3 cases, and eyelid edema, which was the most common alteration in 2 cases. Other alterations included oculomotor restriction, pain, hyperemia, epiphora, and the sensation of a foreign body. Diagnostic accuracy on the basis of the clinical findings of the ophthalmological examination was not achieved. Therapeutic management included resection with bleomycin in 3 patients (60%), orbitotomy in 1 patient (20%), and simple resection in 1 patient (20%).\u003c/p\u003e\n \u003cp\u003eAn exceptional case of arteriovenous malformation was recorded in the right upper eyelid of a 54-year-old patient, with painless swelling for 10 years. The preliminary diagnostic impression was a capillary hemangioma, and the management consisted of simple resection.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eVascular tumors of the orbit and its adnexa represent a topic of utmost importance in the daily practice of ophthalmologists. These tumors can occur at any age, within the seventh decade of life, as found in this series, with the age with the highest prevalence.\u003c/p\u003e \u003cp\u003eThe vascular tumor that occurred most frequently was capillary hemangioma. It is reported in the literature to be the most prevalent in childhood and is more common in female patients (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In our series, capillary hemangioma accounted for 33% of cases in the first two decades of life. Although it predominates in patients over 50 years of age, it remains the tumor with the highest incidence in the pediatric stage, which is consistent with the literature. Therapeutic management in the literature is recommended to be conservative, reserving surgical intervention for cases where vision is compromised or when complete resection can be guaranteed, such as in cases involving the eyelid (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In our study, 100% of capillary hemangiomas were managed with simple resection. One of the differential diagnoses to consider is arteriovenous malformation, as observed in our study.\u003c/p\u003e \u003cp\u003eCavernous hemangioma is the most common primary vascular tumor in adults and is more common in female patients (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The findings in our series correspond to those reported in the literature. Although a predilection for the left side has also been reported, in our series, the prevalence was slightly higher on the right side, differing by just one case. Therapeutic management depends on the symptoms or adjacent damage that may occur; different surgical approaches can be performed depending on the location, or surveillance can be considered, as presented in the cases in our series (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLymphangioma typically manifests in the first two decades of life, as found in our series. It is often associated with slowly progressive painless proptosis accompanied by oculomotor restriction without diplopia. In cases of tumors with infiltrative growth, complete excision is often impossible, leading to a surveillance strategy. Surgical intervention is indicated in cases of complications that threaten vision, such as progressive exophthalmos or acute bleeding. Alternative therapies have also been described, including intralesional injection of sclerosing agents or steroids, fractionated radiation, or CO2 laser ablation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). All the lymphangiomas were managed surgically in our series, with three cases complemented with bleomycin as a sclerosing agent.\u003c/p\u003e \u003cp\u003eOur study has several limitations, as it was a retrospective analysis and had a small sample size due to the nature of the studied pathology. The strengths of the study include a comprehensive description of demographic, clinical, and histopathological aspects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest statement\u003c/h2\u003e \u003cp\u003eThe authors have declared that no competing interests exist.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by GUFA. Analysis was performed by PDAM. The first draft of the manuscript was written by PDAM and GUFA commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchittkowski MP, Fichter N. (2012). Orbitale Neoplasien. Der Ophthalmologe, 109(10), 1033\u0026ndash;1046. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/10.1007/s00347-012-2664-2\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/10.1007/s00347-012-2664-2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShields JA. Diagnosis and Management of Orbital Tumors. 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Adv Dermatol. 1997;13:375\u0026ndash;423.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Benign, Vascular, Tumors, Orbit","lastPublishedDoi":"10.21203/rs.3.rs-6200593/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6200593/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis retrospective study aimed to analyze the incidence of benign vascular tumors in the orbit and ocular adnexa at an ophthalmological hospital over a five-year period and to describe their demographic and clinical characteristics.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThe medical records of patients with vascular tumors in the orbit or ocular adnexa who underwent histopathological studies between 2017 and 2021 were retrospectively reviewed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 30 cases were included. The average age was 40.9 years, and 16 patients (53.3%) were female. Capillary hemangioma was the most prevalent vascular tumor, accounting for 60% of cases, with a mean age of 44 years; 55.5% of these cases were women. Cavernous hemangioma was observed in 23.3% of the patients, with a mean age of 50 years; 71.4% of these patients were women. Lymphangioma was present in 20% of the patients, with an average age of 22 years; 40% of these patients were women. The highest frequency of cases was found in the seventh decade of life, accounting for 20% of the total cases. The third, fifth, and ninth decades presented the lowest frequency, with one case (3.3%) in each.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThis study revealed two significant age peaks in the manifestation of benign vascular tumors. The first peak was prominently observed during the first two decades of life. The second peak occurred in the seventh decade, with a higher incidence among women. Capillary hemangioma has emerged as the most prevalent benign vascular tumor, demonstrating its dominance across all age groups, from childhood through adulthood.\u003c/p\u003e","manuscriptTitle":"Incidence of benign vascular tumors in the orbit and ocular adnexa in an ophthalmological hospital in Mexico","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-13 06:28:32","doi":"10.21203/rs.3.rs-6200593/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e973bf3d-a68e-4409-8f32-4f7855dc8a5b","owner":[],"postedDate":"March 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-02T05:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-13 06:28:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6200593","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6200593","identity":"rs-6200593","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}