Spontaneous visual improvement in orbital apex tumors.

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.