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Late-Onset Chemosis in Patients with Head or Neck Tumors

Harris, Gerald J. M.D.,F.A.C.S.*; Woo, Kyung In M.D.*; Schultz, Christopher J. M.D.; Tayani, Ramin M.D.*; Cancel, Efrain M. M.D.

Ophthalmic Plastic & Reconstructive Surgery: November 2004 - Volume 20 - Issue 6 - p 436-441
doi: 10.1097/01.iop.0000150140.79325.3e

Purpose: To describe a series of patients with chemosis and a history of head or neck tumor, and to propose possible mechanisms for the findings.

Methods: Retrospective, consecutive case series (1993–2001), with review of: site and histopathologic type of the primary tumor; dates and details of tumor treatment; approximate date of chemosis onset; ocular findings and results of orbital, head, and neck imaging upon referral to the authors; and follow-up outcome.

Results: Three male and 3 female patients ranged from 35–68 years of age. Primary tumors were adenoid cystic carcinomas of minor salivary glands of the buccal sulcus (1) and the anterior palate (1), squamous cell carcinomas of the posterior hard palate (1) and the nasopharynx (1), and pleomorphic adenomas of the parotid gland (2). Tumor treatment involved surgery alone (2), surgery and radiation (3), or radiation alone (1). Exposure of regional lymphatics ranged from 50–68 Gy; in 2 cases, orbital exposure was 58–60 Gy. Intervals from treatment to chemosis onset ranged from 5–59 months (mean, 25 months). Imaging showed no orbital mass, recurrence at the primary site, or nodal enlargement in any case. Chemosis remained relatively stable, and no tumor recurrence was noted in additional follow-up of 12–132 months (median, between 26 and 33 months).

Conclusions: Patients with chemosis and a history of head or neck tumor should be evaluated for tumor recurrence at the primary site, in regional nodes, and in the orbital apex. However, the finding may be a delayed sequela of surgery and/or radiation.

Delayed-onset, unremitting chemosis may result from lymphatic and venous insufficiency following surgery and/or radiotherapy for head or neck tumors.

Departments of *Ophthalmology and †Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, and ‡Department of Ophthalmology, Marshfield Clinic, Marshfield, Wisconsin, U.S.A.

Accepted June 14, 2004.

Supported in part by core grant EY01931 from the National Eye Institute, Bethesda, Maryland, and by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York, U.S.A.

Presented in part at the 28th Annual Scientific Symposium, American Society of Ophthalmic Plastic and Reconstructive Surgery, San Francisco, October 25, 1997.

Dr. Woo is currently at the Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address correspondence to Dr. G. J. Harris, Eye Institute, Medical College of Wisconsin, 925 North 87th Street, Milwaukee, WI 53226-4812, U.S.A.

©2004The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.