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| CASE REPORT |
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| Year : 1992 | Volume
: 40
| Issue : 1 | Page : 29-30 |
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Metastatic carcinoma in the orbit. A case report
B Shetty, AG Tyers
Department of Ophthalmology, Odstock Hospital, Salisbury
Correspondence Address:
B Shetty
Department of Ophthalmology, Odstock Hospital, Salisbury
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1464453 
A case of metastatic carcinoma in the orbits from carcinoma in the colon is presented.
How to cite this article:
Shetty B, Tyers A G. Metastatic carcinoma in the orbit. A case report. Indian J Ophthalmol 1992;40:29-30 |
| Introduction | |  |
Carcinoma of the gastrointestinal tract uncommonly metastasises to the orbits. This case is reported because of its uncommon occurrence.
| Case report | | |
A 74 year old lady was referred to the Eye Clinic in October 1989 with discomfort in the left eye for two weeks. There was no history of ocular problems in the past. She gave a history of having had a bowel resection for carcinoma of the colon two years previously. She was in good general health.
On examination no ocular abnormality was found. Her visual acuity was 6/12 unaided in the right eye and 6/9 in the left eye. The optic discs in both eyes were noted to be normal on that visit. She was given Hypromellose eye drops. Two weeks later there was no improvement in her symptoms. At this visit it was noted that the left eye was slightly proptosed and slightly displaced downwards [Figure - 1][Figure - 2]. The left optic disc was swollen [Figure - 3]. The right fundus was normal. The visual acuity was 6/9 unaided in each eye. No mass was palpable in the orbit.
X-Ray examination of the orbits, optic foramina, skull and chest were normal. Orbital tomograms were normal. Full blood count and E.S.R. were normal
During the following three weeks a mass became palpable in the upper medial quadrant of the left orbit.. It was of firm consistency. The location was confirmed with orbital B scan ultrasonography which showed that the mass extended posterior to the globe. Computerized tomography showed a cystic mass in the roof of the left orbit [Figure - 4][Figure 5] and localized areas of thickening in the extraocular muscles in both orbits [Figure - 6]. A biopsy, of the lesion six weeks after presentation [Figure - 7] via an anterior orbitotomy was reported as poorly differentiated adenocarcinoma [Figure 8].
Two weeks later the vision in the opposite (right) eye began to deteriorate. Choroidal folds were noted but the optic disc was normal. The left disc remained swollen and the vision was 6/18 unaided. Liver ultrasound was normal.
She was referred for palliative radiotherapy to the orbits. After three weeks her right visual acuity was reduced to counting fingers at half meter and left visual acuity remained at 6/18 unaided. There was no change in her ocular or orbital signs. This patient died two months later, presumably due to multiple systemic metastases. A post-mortem was not done.
| Discussion | | |
The commonest metastatic tumours to the orbits in the adults are lung carcinoma in men and breast carcinoma in women. Carcinoma of the gastrointestinal tract less commonly metastasises to the orbit and metastases from the colon are rare. One large series of 227 cases of metastases to the eye and orbit included only two from a primary in the colon [1]. The metastases in 23 of the above 227 involved the orbit tissues alone without eye involvement. There was no case of a primary in the colon in this group [2]sub . Bilateral metastases to the orbits, without eye involvement, occurred in only two of the above 227 cases. Bilateral metastases to the eyes occurred in 13 of the 227 cases [1].
Orbital metastatic carcinoma commonly presents with rapidly progressing proptosis often associated with chemosis. There may be periocular pain and discomfort, decreased visual acuity, periorbital swelling, ophthalmoplegia and diplopia. Rarely enophthalmos may occur with metastatic schirrous carcinoma of the breast [2]. Most carcinomas that metastasises to the globe and orbit go through the pulmonary circulation and, hence pulmonary metastases usually accompany ocular and orbital metastases.
Diagnosis depends on biopsy of the orbital lesion. Fine needle aspiration biopsy of orbital metastases has been used to confirm untreatable tumours [3]. However, open biopsy with orbitotomy allows more tissue to be taken for examination.
Since most patients with orbital metastases have only a short period of survival which averages 15.6 months[2], conservative and palliative treatment is appropriate. 3,000 to 4,000 rads to the orbits is given initially and repeated if needed. Orbital metastatic carcinoid tumours are treated by exenteration.
| References | | |
| 1. | Ferry A., Font R. Carcinoma Metastatic to the Eye and Orbit: a Clinicopathological Study of 227 cases Arch. Ophthalmol. 92.276, 1974.  |
| 2. | Ferry A. Font R. A Clinicopathological study of 28 Cases Metastatic to the Orbit. Cancer 38: 1326, 1976. |
| 3. | Dresner S.C.. Kennerdell J. S. Dekker A. Fine Needle Aspiration Biopsy of Metastatic Orbital Tumours Survey of Ophthalmology Vol. 27 6 May . June 1983. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]
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