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 wi thout therapy. Methods: A retrospective chart review of cases in an ac ademic neuro-ophthalmology practice identified three cases of tumorous compression of the optic nerve in which there was spontaneous improve ment in visual function. Each patient had undergone a full neuro-ophth almologic evaluation, followed up with serial imaging. Results: The fi rst 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 initial ly had a visual acuity of 20/40 and a cecocentral visual field defect. After a 4-year follow-wp, her visual acuity had improved to 20/15 and her cecocentral defect had shrunk. The third patient had an initial v isual acuity of 20/25, an afferent pupillary defect, and optic atrophy . Over a 2-year period she developed a paracentral scotoma and her vis ual acuity worsened in 20/30. In the next 2 years her visual acuity im proved to 20/10 and her visual field normalized. Conclusions: In excep tional 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 s hould be a aware that spontaneous remission is compatible with the pre sence of tumor.