[Diplopia as first symptom of a bronchogenic carcinoma].
BACKGROUND



METHODS
In about 30% of patients with orbital metastases, these metastases are detected before the primary tumour is known. Less than 5% of orbital metastases are located in extraocular muscles. We report on a patient with diplopia caused by diminished abduction of the left eye as first symptom of a bronchogenic carcinoma.


METHODS
A 86-year-old patient presented with a newly developed diplopia. On examination, the left eye showed a diminished abduction, ptosis and miosis. Pharmacological testing revealed peripheral Horner's syndrome. On cranial magnet resonance tomography, the lateral rectus muscle belly was enlarged. A chest X-ray showed a large tumour (6 cm in diameter) of the left upper lobe with multiple metastases to the lungs. Further examinations revealed a large cell bronchogenic carcinoma with metastases to the lungs, adrenal glands, and the lateral rectus muscle.


CONCLUSIONS
Diplopia caused by metastases to extraocular muscles is rare as first sign of a bronchogenic carcinoma. The combination of peripheral Horner's syndrome with diminished abduction of the homolateral eye primarily suggests a lesion of the cavernous sinus. The bronchogenic carcinoma could not be causative for Horner's syndrome in the patient presented here, however an undetected tumor-infiltration of the postganglionic region cannot be excluded. This case demonstrates that in all patients with newly developed diplopia and Horner's syndrome, even in absence of orbital signs, apart from a ophthalmological examination detailed radiographic or magnetic resonance tomographic imaging is necessary of both skull base and orbita.
Velten
I M
IM
Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg. isabel.velten@augen.med.uni-erlangen.de
Gusek-Schneider
G C
GC
Tomandl
B
B
D000368:Aged; D000369:Aged, 80 and over; D002283:Carcinoma, Bronchogenic / Q000175:diagnosis* / Q000556:secondary; D003937:Diagnosis, Differential; D004172:Diplopia / Q000209:etiology*; D006732:Horner Syndrome / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D019042:Muscle Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000556:secondary; D009801:Oculomotor Muscles