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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 2  |  Page : 98-100

Bilateral orbital involvement in nasopharyngeal carcinoma


Lala Lajpat Rai Hospital, Kanpur, India

Date of Web Publication22-Dec-2007

Correspondence Address:
K K Gupta
Lala Lajpat Rai Hospital, Kanpur
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Gupta K K, Kulshrestha R P. Bilateral orbital involvement in nasopharyngeal carcinoma. Indian J Ophthalmol 1968;16:98-100

How to cite this URL:
Gupta K K, Kulshrestha R P. Bilateral orbital involvement in nasopharyngeal carcinoma. Indian J Ophthalmol [serial online] 1968 [cited 2019 Dec 12];16:98-100. Available from: http://www.ijo.in/text.asp?1968/16/2/98/37504

Nasopharyngeal tumours are known to cause limitation of ocular involve­ment paralytic diplopia, blurred vi­sion etc. but bilateral extension into the orbits is comparatively rare. SCANLON, RHOPES, WOOLNER, DEVINE and McBEAN [3] found dip­lopia, blurred vision etc. in 15 per cent out of 142 cases of nasopharyn­geal tumours but no proptosis. BOY­CE AND BOLBER [1] observed ocular involvement in 1/3 cases out of 44 studied but no mention is made of bilateral proptosis. NISHIYAMA, BATSAKIS AND WEAVER reported invasion of orbit in one case. The case now reported had bilateral ex­tension into orbits.


  Case report Top


M.A. 15 years male came to us with the presenting symptoms of proptosis and marked diminution of vision in both eyes.

Past History:

The patient developed severe headache and pain in neck follow­ed by epistaxis in January 1967. Two months later swellings appeared on both sides of the neck for which he consulted the E.N.T. specialist. Biop­sy taken from the lateral and poste­rior walls of the nasopharynx on 26th April showed anaplastic carcinoma at places resembling lymphoepithe­lioma. [Figure - 1],[Figure - 2]

He developed diminution of vi­sion in his right eye and fundus examination revealed early optic atrophy. Skiagram showed enlarge­ment of the right optic foramen. He was given deep X-rays for 4 weeks with reduction in size of the swell­ings. Recurrence of swellings took place after two months but with a short course of deep X-ray they sub­sided.

In October 1967 he developed proptosis with marked diminution of vision of the right eye and by Dec­ember 1967, the loss became total and fundus showed complete optic atrophy on the right side. In June 1968 proptosis developed of his left eye ball.


  On examination Top


In June 1968 proptosis appeared in the left eye ball with diminution of vision. The eye ball showed res­tricted movements in all directions and pupillary reaction was sluggish. The fundus showed early macular oedema. In view of the only re­maining eye deep X-ray therapy was not given. Instead Endoxan injec­tions 200 mg. daily intravenously for 10 days were administered but without much improvement. After wait­ing for 10 days a course of radio­therapy was given for 2 weeks, the proptosis subsided and the ocular movements improved. Finally the left eye showed absence of proptosis and full movements but visual acuity got reduced to 6/36 due to macular changes following oedema.


  Discussion Top


Nasopharyngeal carcinoma res­ponds satisfactorily to deep X-ray therapy but when there is ocular in­volvement due to the extension of nasopharyngeal carcinoma, deep X-­ray therapy can be given only at the risk of damaging vision. This can be risked in unilateral ocular involve­ment but the problem is very difficult in bilateral involvement because of the possible damage to both the sides. In the present case Endoxan I/V was tried intravenously but with­out success and in the end deep X­-ray therapy had to be given.


  Summary Top


A case of nasopharyngeal carci­nema with bilateral ocular involve­ment was treated with Endoxon for the second eye but without success. Deep X-ray therapy had to be given involving considerable damage to vi­sion.


  Acknowledgments Top


We are very thankful to Dr. K. C. Sa­muel M.D., Head of the Department of Pathology, for the histopathological exami­nation of the material taken from the na­sopharynx and Dr. K. C. Mathur M.D., D.M.R.E., Reader, Department of Radiology for taking skiagrams and giving radio­therapy to the patient.

 
  References Top

1.
BOYCE D. C. AND BOLKER N. Ocu­lar Manifestations of Primary Naso­pharyngeal Tumours. Am. J. Ophthal, 32, 1354-1358 (1949).  Back to cited text no. 1
    
2.
NISHIYAMA R. H., BATSAKIS J. G. and WEAVER D. K.: Nasopharyngeal carcinoma in children. Archives of Sur­gery 94: 214 (1967).  Back to cited text no. 2
    
3.
SANLON P. W., RHODES R. E. Jr., WOOLNER L. B., DEVINE K. D., AND McBEAN J. B.: Cancer of the nasopharynx, 142 patients treated in the 11 year period 1950-1960. Amer. J. Roentgen. Radium therapy and Nuclear Medicine Vol. 99 No. 2, 313 (1967).  Back to cited text no. 3
    


    Figures

  [Figure - 1], [Figure - 2]



 

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