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Orbital Metastasis From Urothelial Carcinoma

A Comprehensive Literature Review

Sklar, Bonnie A., B.A.*; Gervasio, Kalla A., M.D.; Karmazin, Konstantin, M.D.; Wu, Albert Y., M.D., Ph.D., F.A.C.S.§

Ophthalmic Plastic & Reconstructive Surgery: May/June 2019 - Volume 35 - Issue 3 - p 213–217
doi: 10.1097/IOP.0000000000001256
Major Reviews
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Purpose: To review the clinical features of orbital and choroidal metastases from urothelial carcinomas of the urinary tract among cases reported in the literature, and to describe a case of orbital metastasis from bladder cancer presenting as apparent internuclear ophthalmoplegia.

Methods: Case reports of orbital and choroidal metastases from urothelial carcinomas published in the literature from 1965 to 2018 were reviewed. Data collected included patient demographics, cancer stage and primary site, time to onset of ocular symptoms, length of presenting ocular symptoms, types of primary ocular symptoms, diagnostic imaging, histology, systemic and ocular treatments, and survival time.

Results: Twenty-eight cases of urothelial carcinoma with metastasis to the orbit or choroid were reviewed. Men were significantly more likely to suffer from this condition than women (p = 0.011). The average age of presentation with orbital symptoms was 63 years, with an average time of 19 months between primary cancer diagnosis and onset of orbital symptoms. Twenty-two patients had metastasis to the orbit and 6 to the choroid. In 4 cases, ocular deficits secondary to orbital and/or choroidal metastases were the initial presenting symptoms in patients with previously undiagnosed urothelial carcinoma. The most commonly noted primary ocular symptoms and signs consisted of decreased visual acuity, decreased ocular motility, proptosis, and diplopia. Average survival from onset of ocular symptoms was 4.67 months.

Conclusions: Urothelial carcinoma may metastasize to the orbit or choroid; furthermore, its presentation may mimic internuclear ophthalmoplegia. It is recommended that any patient with visual symptoms and known urothelial cancer should undergo expedited workup for metastatic disease.

This major review analyzes 28 published cases of orbital and choroidal metastases from urothelial carcinomas and describes a case in which orbital metastasis from bladder cancer presented as apparent internuclear ophthalmoplegia.

*Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York

Department of Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania

Department of Neurology, Columbia University Irving Medical Center, New York, New York

§Department of Ophthalmology, Byers Eye Institute, Stanford School of Medicine, Palo Alto, California, U.S.A.

Accepted for publication September 8, 2018.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Bonnie A. Sklar, B.A., Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029. E-mail: bonnie.sklar@icahn.mssm.edu

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.