Diplopia as first symptom of a bronchogenic carcinoma

Background: Patients: In about 30% of patients with orbital metastases, the se metastases are detected before the primary tumour is known. Cess than 5% of orbital metastases are located in extraocular muscles. We report on a p atient with diplopia caused by diminished abduction of the left eye as firs t symptom of a bronchogenic carcinoma. Patient: A 86-year-old patient presented with a newly developed diplopia. O n examination, the left eye showed a diminished abduction, ptosis and miosi s. Pharmacological testing revealed peripheral Horner's syndrome. On crania l magnet resonance tomography, the lateral rectus muscle belly was enlarged . A chest X-ray showed a large tumour (6 cm in diameter) of the left upper robe with multiple metastases to the lungs. Further examinations revealed a large cell bronchogenic carcinoma with metastases to the lungs, adrenal gl ands, and the lateral rectus muscle. Conclusions: Diplopia caused by metastases to extraocular muscles is rare a s first sign of a bronchogenic carcinoma. The combination of peripheral Hor ner's syndrome with diminished abduction of the homolateral eye primarily s uggests a lesion of the cavernous sinus. The bronchogenic carcinoma could n ot be causative for Horner's syndrome in the patient presented here, howeve r an undetected tumor-infiltration of the postganglionic region cannot be e xcluded. This case demonstrates that in all patients with newly developed d iplopia and Horner's syndrome, even in absence of orbital signs, apart from a ophthalmological examination detailed radiographic or magnetic resonance tomographic imaging is necessary of both skull base and orbita.