Two Cases of Extraocular Muscle Enlargement Caused by Metastatic Cancer

Jae Woo Jung; Jae Ho Jung

doi:10.3341/jkos.2016.57.8.1320

Journal List > J Korean Ophthalmol Soc > v.57(8) > 1010380

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Jung and Jung: Two Cases of Extraocular Muscle Enlargement Caused by Metastatic Cancer

Case Report

J Korean Ophthalmol Soc 2016;57(8):1320-1324.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1320

Two Cases of Extraocular Muscle Enlargement Caused by Metastatic Cancer

Jae Woo Jung, MD, Jae Ho Jung, MD, PhD

Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Address reprint requests to Jae Ho Jung, MD, PhD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2131, Fax: 82-55-360-2161 E-mail: jungjaeho@pusan.ac.kr

Received 7 April 2016 Revised 4 May 2016 Accepted 1 July 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Diplopia, Extraocular muscle enlargement, Extraocular muscle metastasis, Paralytic strabismus

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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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