ASHNR '98'

uhrad.com - Case #5

Clinical History: A 72 year old female with proptosis.

Metastases To The Extraocular Muscles

Findings: There are multiple nodules scattered throughout the orbits with involvement of extraocular muscles, the lacrimal glands and Tenon’s space bilaterally. There is sparing of the globes themselves and of the optic nerves. Following contrast injection there is enhancement as seen on the coronal image in the lower right hand screen.

Metastatic disease to the orbits and extraocular muscles represents 7% of all causes of enlarged extraocular muscles. There is an increasing incidence of orbital metastases as patients survive their primary neoplasms longer. Primaries within the breast are the most common sites of origin for metastasis to the extraocular muscles. Lung and prostate primaries also metastasize to the orbits. Although not illustrated in this case, one of the hallmarks of breast metastases to the extraocular muscles includes enophthalmos because of the scirrhous reaction. Most orbital breast metastases occur approximately three years from the time of diagnosis. The differentiation from thyroid ophthamopathy and pseudotumor is made by recognizing segmental or nodular involvement rather than diffuse involvement.

References:
Goldberg. Metastases to the Orbit. Journal of Surgical Ophthamology. 1990;35:1.

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