PURPOSE: To evaluate the outcome of surgical excision of large and massive orbital tumors. To the best of our knowledge, this is the first article to evaluate the relationship between the size of orbital tumors and the surgical outcome. METHODS: We retrospectively reviewed the charts of 34 consecutive patients affected by large or massive orbital tumors that underwent orbitotomy with en-bloc excision of the lesion. The main outcome measures included visual acuity, visual field testing, extraocular motility, pupillary function, and Hertel exophthalmometry readings. Follow-up time ranged from 1 to 4 years. RESULTS: Complications of the surgical intervention included 1 patient with visual loss (2.9%), 2 patients with third nerve palsy (5.8%), and 6 patients with de novo strabismus (17.6%). In this setting, enophthalmos was an expected outcome more than a true complication and occurred in 5 patients (14.7%). CONCLUSIONS: Although this is a relatively small and retrospective series, these findings suggests that the surgical excision of large and massive orbital tumors carries significant risks of surgical complications including visual loss, enophthalmos, strabismus, and third nerve palsy. These complications may occur as consequence of excessive traction, reduced working room, blind dissection behind the increased bulk of the tumor, or release of tight adhesions between the tumor and the surrounding orbital structures.
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