A 44-YEAR-OLD MAN WITH CARCINOMA OF THE CARDIA AND PARANEOPLASTIC ORBITAL INVOLVEMENT

History and clinical findings: Bilateral orbital involvement with chem osis, protrusion and reduced vision developed in a 44-year-old man 12 weeks after carcinoma of the cardia with lymph node metastases and per itoneal carcinomatosis had been diagnosed and palliative chemotherapy with a cycle of leucovorin and 5-fluouracil had been concluded. Invest igations: Computed tomography excluded a retrobulbar metastasis, Thyro id hormone concentration was normal as was the thyroid autoantibody ti tre. There was also no evidence on sonography of endocrine orbital dis ease. These findings established the diagnosis of paraneoplastic orbit al myositis. Treatment and course: The symptoms briefly regressed on i nitial treatment with systemically administered high doses of corticos teroids, Renewed marked eyeball protrusion with incipient visual loss was treated with conjunctival drainage and tarsorrhaphy, as well as ra diotherapy to the retrobulbar space. This achieved significant improve ment, Shortly thereafter the patients died of acute bleeding from the primary tumour. Conclusion: In patients with an underlying malignancy and symptoms of orbital myositis orbital involvement as part of a para neoplastic syndrome should be diagnosed once other causes have been ex cluded.