J Korean Ophthalmol Soc.  2016 Aug;57(8):1320-1324. 10.3341/jkos.2016.57.8.1320.

Two Cases of Extraocular Muscle Enlargement Caused by Metastatic Cancer

• Jung JW
• Jung JH

• KMID: 2349084
• DOI: http://doi.org/10.3341/jkos.2016.57.8.1320

Abstract

PURPOSE
To report two cases of extraocular muscle enlargement due to malignant cancer metastasis.
CASE SUMMARY
A 56-year-old woman presented with horizontal diplopia first noted 1 month earlier. She had a history of small cell lung cancer with brain and bone metastases. She had a -3 abduction deficit in the right eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Brain magnetic resonance image showed multiple nodular enlargements of the right lateral and medial rectus muscles, al so multiple metastatic nodules in the brain. A 38-year-old woman presented with horizontal diplopia first noted 3 months previously. She had undergone breast cancer surgery 6 months earlier. The patient had a -4 abduction deficit in the left eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Orbital magnetic resonance imaging showed nodular enlargement of left lateral rectus muscle including a tendon.
CONCLUSIONS
Extraocular muscle metastasis is a possible cause of extraocular enlargement and paralytic strabismus. In a patient with malignant cancer, the physician should consider the possibility of extraocular muscle metastasis and perform imaging for early diagnosis and treatment.

Keyword

Diplopia; Extraocular muscle enlargement; Extraocular muscle metastasis; Paralytic strabismus

MeSH Terms

Adult
Brain
Breast Neoplasms
Diplopia
Early Diagnosis
Esotropia
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Muscles
Neoplasm Metastasis
Orbit
Small Cell Lung Carcinoma
Strabismus
Tendons
Thyroid Diseases

Figure

• 

  Figure 1. Photograph of case 1. (A) The patient had limitation of abduction in the right eye. (B) Axial image of T1-weighted contrast enhanced brain magnetic resonance showed nodular enlargement with heterogenous high signal intensities in the right lateral and medial rectus muscles.

• 

  Figure 2. Photograph of case 2. (A) The patient had limitation of abduction in the left eye. (B) Axial image of T1-weighted contrast enhanced orbital magnetic resonance showed high signal intensities and large nodular enlargement in the left lateral rectus muscle including lateral rectus muscle tendon.

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