Ocular involvement in metastatic and systemic malignancies is not rare

Abstract

Background: Metastatic disease to the eye most commonly involves choroid followed by orbit leading to varied ocular manifestations. By comparison, it is relatively rarer than primary malignancies of eye as well as metastasis in other parts of the body.

Aim: The aim of this study is to evaluate the common eye and orbital structures involved in secondary ocular and metastatic disease, to describe its clinical manifestations and outline the management done.

Methods: A retrospective study of newly diagnosed cases of ocular metastasis in last 2 years conducted in our recently established department of ocular oncology at a tertiary eye care hospital in Nepal. Demography, age and sex distribution were noted. The patients were segregated into those with secondary or metastatic ocular malignancies. Detail study on the metastatic disease to eye was made in regards to presenting symptoms, signs, primary site of cancer, and the treatment done. Details of the investigations done, like biopsy and imaging were also recorded.

Results: There were a total of 28 patients, whose age group ranged from 9 years to 69 years with median age of 43 years. Females constituted 46% of total patients. Both the eyes were involved in 9 patients (32%). Eye was secondarily involved by paranasal sinus tumors and Non Hodgkin lymphoma (7 patients each). Ocular metastasis was commonly seen from broncogenic carcinoma in four and breast carcinoma in three patients. Simultaneous metastasis to other parts of the body was also seen in 61% of our patients. Diminution of vision in 49% was the most common presenting feature followed by proptosis in 16% and palpable mass in 14% of patients. Orbit in 43% cases is the commonest ocular structure involved. Histopathologic diagnosis was done in 32% only while rest was based on imaging alone. The most common treatment done was chemotherapy in 57% patients.

Conclusion: Ocular metastasis can display a wide variety of clinical and imaging features and therefore a high degree of suspicion is required. It is often associated with simultaneous metastasis to other parts of the body as well, hence the importance of earlier diagnosis and metastatic workup.

Keywords: choroidal metastasis; eye cancer; ocular malignancy; ocular metastasis; orbital metastasis.

FIGURE 1

Breast carcinoma metastasizing to orbit and temporal fossa

FIGURE 2

Clinical features at presentation

FIGURE 3

Ocular structures involved in secondary tumors

FIGURE 4

Sinonasal carcinoma invading left orbit. (A) Presenting as proptosis. (B) MRI image showing maxillary carcinoma invading the floor and retrobulbar orbit

FIGURE 5

Orbital infiltration of Non‐Hodgkin lymphoma. (A) Conjunctival and orbital lymphoma. (B) CT scan image showing bilateral diffuse orbital infiltration