Spontaneous visual improvement in orbital apex tumors
M. Pless and S. Lessell
Neuro-Ophthalmology Units, Brigham and Women's Hospital, Boston, Mass, USA.
OBJECTIVE: To describe patients with orbital apex masses involving the
optic nerve who enjoyed spontaneous improvement in visual function without
therapy. METHODS: A retrospective chart review of cases in an academic
neuro-ophthalmology practice identified three cases of tumorous compression
of the optic nerve in which there was spontaneous improvement in visual
function. Each patient had undergone a full neuro-ophthalmologic
evaluation, followed up with serial imaging. RESULTS: The first patient
initially had a visual acuity of 2/200 and central visual field defects.
Over a 4-year period, her visual acuity improved to 20/40 and her visual
field expanded centrally. The second patient initially had a visual acuity
of 20/40 and a cecocentral visual field defect. After a 4-year follow-up,
her visual acuity had improved to 20/15 and her cecocentral defect had
shrunk. The third patient had an initial visual acuity of 20/25, an
afferent pupillary defect, and optic atrophy. Over a 2-year period she
developed a paracentral scotoma and her visual acuity worsened to 20/30. In
the next 2 years her visual acuity improved to 20/10 and her visual field
normalized. CONCLUSIONS: In exceptional instances, visual dysfunction from
tumorous compression of the optic nerve in the orbital apex may
spontaneously improve. Clinicians who use the natural history of visual
loss in differential diagnosis should be aware that spontaneous remission
is compatible with the presence of tumor.
