Management of the eye in the treatment of sinonasal cancers.

Malignant neoplasms of the nose and paranasal sinuses typically manifest at a late stage and commonly abut or invade the orbit. Careful ophthalmologic examination and fine-cut CT provide the most accurate preoperative assessment of orbital involvement, providing guidance for treatment with a combination of radiation therapy and surgical resection. Although some surgeons still aggressively remove the eye when tumor abuts or involves limited periorbita, we have shown that this approach is unnecessarily ablative. The cosmetic, functional, and psychologic consequences of the loss of an eye mandate that every effort should be made to preserve the eye as long as oncologic safety is not compromised. The evidence is mounting that this is safe and organ sparing, and leaves functioning eyes. With the use of preoperative radiation therapy and frozen-section control of the periorbita, the eye can often be spared without increasing local recurrences or survival, and adequate postoperative function can be maintained.