|Year : 1968 | Volume
| Issue : 2 | Page : 98-100
Bilateral orbital involvement in nasopharyngeal carcinoma
KK Gupta, RP Kulshrestha
Lala Lajpat Rai Hospital, Kanpur, India
K K Gupta
Lala Lajpat Rai Hospital, Kanpur
|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 2013 May 23];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  found diplopia, blurred vision etc. in 15 per cent out of 142 cases of nasopharyngeal tumours but no proptosis. BOYCE AND BOLBER  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|| |
M.A. 15 years male came to us with the presenting symptoms of proptosis and marked diminution of vision in both eyes.
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|| |
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|| |
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|| |
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|| |
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|| |
|1.||BOYCE D. C. AND BOLKER N. Ocular Manifestations of Primary Nasopharyngeal Tumours. Am. J. Ophthal, 32, 1354-1358 (1949). |
|2.||NISHIYAMA R. H., BATSAKIS J. G. and WEAVER D. K.: Nasopharyngeal carcinoma in children. Archives of Surgery 94: 214 (1967). |
|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). |
[Figure - 1], [Figure - 2]