Orbital metastasis: Clinical presentation and survival in a series of 11 cases.

BACKGROUND AND OBJECTIVE: Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20%-42%. The clinical presentation and survival is presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS: Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastasis involving the orbit was included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS: One-half (50%) of the patients were women. Mean age at diagnosis was 60.9 years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases); followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation, and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8 months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5 months) and in the active treatment group (median 29.2 months), p=.034. CONCLUSIONS: In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.

Metástasis orbitarias: presentación clínica y supervivencia en una serie de 11 casos / Orbital metastasis: Clinical presentation and survival in a series of 11 cases

Antecedentes y objetivoLas metástasis orbitarias son una entidad infrecuente y pueden suponer la presentación de un tumor maligno desconocido previamente; según las series, el porcentaje de metástasis orbitarias como primera manifestación de una enfermedad maligna es del 20-42%. Describimos la presentación clínica y la supervivencia en una serie de 11 casos de metástasis orbitarias correspondientes a 10 pacientes.Material y métodosEstudio descriptivo retrospectivo de una serie de 10 pacientes adultos diagnosticados de metástasis orbitarias de tumores sólidos durante un periodo de 9años. Se incluyeron metástasis que afectasen a la órbita, excluyendo linfomas e invasiones por contigüidad. Se especificó si la clínica fue la primera manifestación del tumor. Se registraron los síntomas y signos en el debut clínico, la localización del tumor primario, si existía extensión a distancia, las estructuras orbitarias afectas y el tiempo de supervivencia desde el diagnóstico.ResultadosLa mitad de los pacientes fueron mujeres. La edad media al diagnóstico fue de 60,9años (rango 42-82). En 9casos (90%) la metástasis fue unilateral, mientras que en el restante la afectación fue bilateral. La localización más frecuente del tumor primario fue la mama (36% de los casos), seguida por la vejiga (27%), el pulmón (18%), el ovario y el cavum (9%). El 70% de los pacientes tenían enfermedad neoplásica diagnosticada previamente; en 3casos la metástasis fue la primera manifestación del tumor.

Background and objectiveOrbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20-42%. The clinical presentation and survival are presented in a series of 11 cases of orbital metastasis corresponding to 10 patients.Material and methodsDescriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastases involving the orbit were included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established.ResultsOne-half (50%) of the patients were women. Mean age at diagnosis was 60.9years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases), followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%).

Orbital metastasis: Clinical presentation and survival in a series of 11 cases. / Metástasis orbitarias: presentación clínica y supervivencia en una serie de 11 casos.

BACKGROUND AND OBJECTIVE: Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20-42%. The clinical presentation and survival are presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS: Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastases involving the orbit were included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS: One-half (50%) of the patients were women. Mean age at diagnosis was 60.9years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases), followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5months) and in the active treatment group (median 29.2months), P=.034. CONCLUSIONS: In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.

[Fractionated stereotactic radiotherapy in optic nerve sheath meningioma]. / Radioterapia fraccionada estereotáctica en el meningioma del nervio óptico.

CASE REPORT: A 56-year-old woman with a right optic nerve sheath meningioma and visual loss, was treated with fractionated stereotactic radiotherapy. This resulted in an almost complete recovery of her visual acuity. DISCUSSION: Currently there are many different alternatives available for the management of an optic nerve sheath meningioma: observation, surgery, conventional radiotherapy and fractionated stereotactic radiotherapy. The last of these treatments has been demonstrated to preserve or improve vision in 2 out of 3 treated patients, with fewer side effects, and has not been associated with recurrent disease or tumor progression.

Radioterapia fraccionada estereotáctica en el meningioma del nervio óptico / Fractionated stereotactic radiotherapy in optic nerve sheath meningioma

Caso clínico: Mujer de 56 años con meningioma del nervio óptico derecho y pérdida de visión tratada con radioterapia fraccionada estereotáctica, mejorando la visión casi en su totalidad. Discusión: Actualmente existen diversas alternativas en el manejo del meningioma del nervio óptico: observación, cirugía, radioterapia convencional y radioterapia fraccionada estereotáctica. Esta última es la única técnica que ha demostrado preservar o mejorar la visión en dos de cada tres pacientes tratados, con menor tasa de efectos secundarios y ausencia de recidiva o progresión tumoral

Case report: A 56-year-old woman with a right optic nerve sheath meningioma and visual loss, was treated with fractionated stereotactic radiotherapy. This resulted in an almost complete recovery of her visual acuity. Discussion: Currently there are many different alternatives available for the management of an optic nerve sheath meningioma: observation, surgery, conventional radiotherapy and fractionated stereotactic radiotherapy. The last of these treatments has been demonstrated to preserve or improvevision in 2 out of 3 treated patients, with fewer side effects, and has not been associated with recurrent disease or tumor progression

[Bilateral sixth nerve and left third nerve palsy after head trauma]. / Parálisis del VI par bilateral y III par izquierdo postraumático.

CASE REPORT: To describe a case of combined bilateral cranial nerve palsy of traumatic origin. To determine the lesions that produce the symptoms is useful to define the final prognosis and the best treatment. DISCUSSION: We report the case of a patient who developed a bilateral sixth nerve and left third nerve palsy after head trauma. The underlying lesion was a diffuse axonal injury. After an observation period during which no spontaneous improvement occurred, we administered botulinum toxin with a successful clinical result. Bilateral combined traumatic cranial nerve palsies are rare. When a diffuse axonal injury is present, the chance of spontaneous resolution is poor.

Parálisis del VI par bilateral y III para izquierdo postraumático / Bilateral sixth nerve and left third nerve palsy after nead trauma

Caso clínico: Describir un caso de parálisis bilateral combinada de origen traumático. Conocer las lesiones que ocasionan la clínica nos es útil para inferir el pronóstico final y tratamiento más adecuado.Discusión: Presentamos un paciente con una parálisis del III par izquierdo y VI par bilateral de origen traumático. El daño anatomofuncional era una lesión axonal difusa. Tras un período de observación sin presentar mejoría se realizó una inyección de toxina botulínica con la que mejoró clínicamente. Las lesiones de pares craneales combinadas y bilaterales traumáticas son infrecuentes. Si son por un daño axonal difuso las expectativas empeoran

Case report: To describe a case of combined bilateral cranial nerve palsy of traumatic origin. To determine the lesions that produce the symptoms is useful to define the final prognosis and the best treatment.Discussion: We report the case of a patient who developed a bilateral sixth nerve and left third nerve palsy after head trauma. The underlying lesion was a diffuse axonal injury. After an observation period during which no spontaneous improvement occurred, we administered botulinum toxin with a successful clinical result. Bilateral combined traumatic cranial nerve palsies are rare. When a diffuse axonal injury is present, the chance of spontaneous resolution is poor

[Treatment of nasolacrimal duct obstruction with Song's stent. Long term efficacy]. / Tratamiento de la obstrucción del conducto naso-lagrimal mediante prótesis de Song. Eficacia a largo plazo.

PURPOSE: To evaluate the long-term efficacy (5 years) of Song's stent in the treatment of naso-lachrymal duct obstruction. MATERIALS AND METHODS: We examined Song's stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. CLINICAL PRESENTATION: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. RESULTS: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. CONCLUSIONS: Song's stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency.

Tratamiento de la obstrucción del conducto naso-lagrimal mediante prótesis de Song: Eficacia a largo plazo / Treatment of nasolacrimal duct obstruction with songs stent. Long term efficacy

Objetivo: Evaluar la eficacia a largo plazo (5 años) de la prótesis nasolagrimal de Song en el tratamiento de la obstrucción del conducto naso-lagrimal. Material y métodos: Se estudiaron 64 ojos (62 pacientes) con prótesis de Song por obstrucción del conducto naso-lagrimal (CNL), 48 mujeres y 14 hombres de edad media 60 años DE 13,17. El lado más frecuentemente obstruido fue el derecho (62,5%), siendo en el ojo izquierdo de 37,5%; y el tipo de obstrucción en la dacriocistografía: unión CNL-saco 82,8%, CNL distal 10,9%, CNL medio 3,1%, y proximal y completo, ambos del 1,6%. La clínica previa más frecuente fue la epífora (96,8%), dacriocistitis aguda (67,2%), conjuntivitis de repetición (25%) y mucocele (17,2%). El tiempo medio de seguimiento fue de 25,23 meses (máximo 53 y mínimo 2). Resultados: Durante el seguimiento se retiraron 13 prótesis y recambiaron 2. Al final siguen permeables 43 (67,2%); la epífora se redujo al 32,8% y el número de episodios de dacriocistitis aguda, conjuntivitis de repetición y mucocele se redujo al 1,6%. El 73,5% de los encuestados manifestaron una mejoría subjetiva. La complicación intraoperatoria más frecuente fue la epístaxis (15,6%) y dolor (14,1%), y de las post-operatorias la obstrucción en 22 casos, con un tiempo medio de 8,6 meses. Conclusiones: La prótesis de Song es una opción útil y rápida en el tratamiento de las obstrucciones del CNL. Pese a no ser eficaz en todos, produce una mejoría sintomática en la mayoría, permitiendo evitar la cirugía. No obstante, se requieren lavados periódicos para mantener su permeabilidad(AU)

Purpose: To evaluate the long-term efficacy (5 years) of Songs stent in the treatment of naso-lachrymal duct obstruction. Materials and methods: We examined Songs stents installed in 64 eyes from 62 patients with naso-lachrymal duct obstruction (NLD). Of the 64, 48 were women and 14 men of mean age 60 SD 13.17 years. Obstructions of right side 62.5% and left side 37.5%, and location in dacriocystography: sac-NLD junction 82.8%, distant NLD 10.9%, medium NLD 3.1% and both proximal and complete NLD 1.6%. Clinical presentation: chronic epiphora 96.8%, acute dacriocystitis 67.2%, purulent discharge 25% and mucocele 17.2%. Mean follow-up period was 25.23 months. Results: 13 stents were removed and 2 changed during the follow-up. 67.2% were patent at the end of the study; epiphora reduced to 32.8%, number of acute dacryocystitis, purulent discharge and mucocele to 1.6%. Subjective improvement was found in 73.5%. Surgical complications included epistaxis (15.6%) and pain (14.1%), and post-operative complications included reobstruction in 22 cases within a mean time of 8.6 months. Conclusions: Songs stent is a quick and useful option in treatment of epiphora. Despite not being efficient in all cases, it leads to improvement of symptoms and avoidance of surgery in the majority of cases. However, it requires periodical washes to maintain its patency(AU)

Amaurosis bilateral como secuela de la intoxicación aguda por metanol: a propósito de un caso / Bilateral blindness as a consequence of acute methanol intoxication: a case report

La intoxicación por metanol supone una preocupación para la salud pública y ambiental por las acciones selectivas de su metabolito neurotóxico, formaldehído en la retina, nervio óptico y sistema nervioso central. Se presenta un caso de ceguera por metanol y se discute su fisiopatología, diagnóstico y tratamiento. Pese a que esta neuropatía es rara actualmente, el diagnóstico precoz y el tratamiento adecuado son cruciales para mejorar el pronóstico (AU)