Clinical, Radiological, and Histopathological Spectrum of Orbital Masses: A Systematic Review and Meta-Analysis

Abstract

Purpose: To systematically evaluate the clinical presentation, radiologic characteristics, histopathological distribution, and treatment outcomes of orbital masses across diverse populations through a comprehensive meta-analysis.
Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Electronic databases including PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library were searched from inception to the final search date. Observational studies reporting clinical, imaging, and histopathological data on orbital masses were included. Random-effects meta-analysis was performed to calculate pooled prevalence estimates with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated through funnel plot analysis and Egger’s test.
Results: A total of 110 studies comprising 18,742 patients from 32 countries were included, with 78 studies eligible for quantitative synthesis. Benign tumors constituted the largest category of orbital masses (34; 95% CI 29–39%), followed by inflammatory lesions (28; 95% CI 24–32%) and malignant tumors (26; 95% CI 22–30%). Vascular (8%) and metastatic lesions (4%) were less common. Proptosis was the most frequent presenting symptom (63%). Malignant lesions were significantly associated with bone invasion (OR 3.21) and intracranial extension (OR 2.87). Subgroup analyses demonstrated age-related differences, with malignant lesions relatively more prevalent in pediatric populations.
Conclusion: Orbital masses exhibit substantial clinical and pathological heterogeneity. While benign and inflammatory lesions predominate, significant proportions are malignant, emphasizing the necessity of integrated clinical, radiologic, and histopathologic evaluation to optimize diagnosis and management.