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A man in his early 70s presented with a 3-month history of decreased vision, pain, redness, and proptosis of the left eye. His medical history was significant for metastatic gastrointestinal carcinoid following small-bowel resection and chemotherapy. His visual acuity was 20/20 OD and hand motions OS with a relative afferent pupillary defect on the left. Extraocular motility was severely limited in both eyes. Orbital magnetic resonance imaging findings are displayed in the Figure. Bilateral orbital decompression was performed with biopsy of the left inferior rectus muscle, which revealed metastatic neuroendocrine carcinoma. Immunohistochemical stains, including cytokeratin AE1/AE3, chromogranin, and synaptophysin, confirmed the diagnosis. Orbital radiation was performed with rapid improvement in his proptosis. Despite this, the vision remained poor and the patient died of widespread metastatic disease. Orbital metastasis from carcinoid tumors is rare and typically occurs as a solitary lesion. Few reports exist of bilateral orbital metastases involving all the extraocular muscles.1
Warren CC, Liao JC, Griepentrog GJ. Bilateral Extraocular Muscle Metastases From a Gastrointestinal Carcinoid Tumor. JAMA Ophthalmol. 2016;134(1):e153651. doi:10.1001/jamaophthalmol.2015.3651