Orbit
Monitoring Orbital injury
It is recommended that survivors of childhood cancer have yearly re-evaluations with their HCP for chronic health problems.
Screening for late orbital problems should include a history to ascertain if there are any symptoms of:
- Visual changes:
- Diplopia
- Visual loss (decreased acuity)
- Halos
- Poor night vision
- Dry eye problems:
- Persistent eye irritation
- Burning and itching
- Foreign body sensation
- Excessive tearing
- Increased light sensitivity
- Painful eye.
Physical examination should assess:
- Visual acuity
- Cranial nerve function
- Fundoscopy
An ophthalmologist should be consulted for continued symptomatic or refractory ocular symptoms (for example dry eyes). Prompt and correct attention may prevent visual loss4
Dry Eyes:
Patients should be followed closely with Schirmer tests to assess the degree of wetting (tear production) and to intervene early at the onset of ocular involvement even before any severe symptoms develop6
Other:
In young patients below the age of 7, the visual pathways in the brain are still developing and any altered visual stimuli during this time such as through an opaque lens may result in amblyopia and permanent alterations in vision.
These altered visual stimuli must be identified as they are potentially reversible when discovered early enough4
Comprehensive ocular care is necessary consisting of photoprotection (UV protection) with regular evaluation for infection, cataract formation and increased intraocular pressure6:
Other patient care measures may include:
- Artificial tears
- Ocular ointments
- Punctal occlusion
- Humidified environment
- Occlusive eye wear
- Moisture chamber
- Eyeglasses
- Glass permeable scleral contact lens
Links to patient directed health advice:
COG Survivorship Guidelines: Keeping your eyes healthy after treatment for childhood cancer
COG Survivorship Guidelines: Cataracts after treatment for childhood cancer
