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Case Report: Adenocarcinoma of the Lacrimal Gland Presenting as an Abduction Deficit

DeLuca, Crystal L. OD, FAAO1*; Zimmers, Regina E. OD2

doi: 10.1097/OPX.0000000000001149
Reports

SIGNIFICANCE It is imperative to follow the clinical guidelines for abduction deficits to ensure prompt diagnosis of potentially serious etiologies and monitor only those in which a microvascular etiology is most likely. This case reports highlights a rare diagnosis of a malignant tumor of the lacrimal gland presenting as an abduction deficit.

PURPOSE Tumors of the lacrimal gland can cause abduction deficits, which may mimic an abducens nerve palsy. Abducens nerve palsies are often encountered by optometrists. This case report highlights the appropriate workup of an abduction deficit and reviews the literature of adenocarcinoma not otherwise specified.

CASE REPORT A 67-year-old white man was transferred to the optometry clinic with a presumed ischemic abducens palsy. He was found to have an isolated left abduction deficit without vascular risk factors that prompted neuroimaging revealing a mass of the lacrimal gland. After an en bloc resection, a diagnosis of adenocarcinoma not otherwise specified was made. The patient underwent aggressive surgical exenteration followed by radiation.

CONCLUSIONS Using the guidelines for evaluation of an abduction deficit, this serious malignancy was diagnosed. An adenocarcinoma not otherwise specified of the lacrimal gland is rare, and there are limited data on its clinical course, prognosis, and treatment. Recurrence and metastases occur at high rates; therefore, prompt diagnosis and aggressive intervention are crucial.

1VA Nebraska-Western Iowa Healthcare System, Bellevue, Nebraska

2VA Cheyenne Healthcare System, Cheyenne, Wyoming *crystal.deluca2@va.gov

Submitted: May 11, 2017

Accepted: August 22, 2017

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions and Acknowledgments: Writing – Original Draft: CLD, REZ; Writing – Review & Editing: CLD, REZ.

This case report was presented as a poster at the American Academy of Optometry Annual Meeting; October 9, 2015; New Orleans, LA.

In no way does this medical case report reflect the views of the Department of Veterans Affairs, its agents or assigns. This report is published as a factual medical history for educational purposes only and meant to neither endorse nor condemn any medical manufacturer, facility, or provider. In addition, this case report does not serve as a replacement for personal health care from a licensed professional practitioner. As such, any lay reader should beware of misinterpreting this case report, which is written and edited for health care professionals and which may be easily misconstrued without the benefit of professional health care training and experience.

© 2017 American Academy of Optometry