Metastasis of small cell lung cancer to bilateral extraocular muscles: a case report

TL;DR

A rare case of small cell lung cancer spreading to both extraocular muscles is reported, highlighting the challenges in treatment.

Contribution

This case report documents a rare bilateral metastasis pattern of small cell lung cancer to the extraocular muscles.

Findings

Bilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer.

Palliative treatment combining chemotherapy and ophthalmological interventions was used, but the patient's condition deteriorated.

The case emphasizes the diagnostic and therapeutic challenges in managing such rare metastatic patterns.

Abstract

Orbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature.

A 46-year-old white male with a past medical history of smoking and stage IV small cell lung carcinoma presented with loss of vision and pain in the left eye. Examination revealed bilateral proptosis and left afferent pupillary defect, and visual acuity was hand motion on the left eye and 4/10 on the right eye. An orbital computed tomography scan showed a compression of the left optic nerve between the extraocular muscles at the apex, and a lateral canthotomy was performed for a new-onset compressive optic neuropathy, with residual visual improvement. There was also significant enlargement of the extraocular muscles in the right orbit. The patient was maintained in palliative treatment with both chemotherapy and local medical and surgical (amniotic membrane cover for exposure keratopathy) ophthalmological treatments until he eventually died 5 months after.

Bilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer and the palliative treatment in these cases is challenging.

Figures