Infiltrative optic neuropathy in a patient with esophageal adenocarcinoma

October 4, 2020

Dr M.M. Alberto Pestano explains how optic neuropathy can present as a masquerade syndrome. He highlighted a case of unilateral infiltrative optic neuropathy that presented as a masquerade syndrome in a man with esophageal adenocarcinoma.

Adenocarcinoma can metastasise to the optic nerve and Spanish investigators reported just such a case of unilateral infiltrative optic neuropathy that presented as a masquerade syndrome in a man with esophageal adenocarcinoma.

Dr M.M. Alberto Pestano and colleagues reported the case of man with unilateral infiltrative optic neuropathy being treated for esophageal adenocarcinoma who presented to the Ophthalmology Department, University Hospital Nuestra Señora de Candelaria, Tenerife, Canary Island, Spain, and reported loss of vision in one eye.

The patient was a 74-year-old man who was undergoing chemotherapy to treat esophageal adenocarcinoma that had not metastasised. He reported a 10-day loss of visual acuity in his right eye. Upon examination, the best-corrected visual acuity was light perception. He also had an afferent pupillary defect.

A funduscopic examination showed fibrin in the vitreous cavity and the retina was not visualised as a result. An ultrasonography examination showed hyperechogenic proliferation extending from the optic nerve to the vitreous cavity. No pathologic findings were seen on magnetic resonance images.

The patient underwent a diagnostic vitrectomy and the investigators observed swelling of the optic disc, which was seen to be infiltrated by a yellowish mass. A cytologic study of vitreous confirmed the presence of malignant cells.

One week after the surgery, the patient presented with pseudohypopyon and fibrin in the vitreous cavity. The intraocular pressure was 2 mmHg. Carcinomatous involvement of the ciliary body was suspected. The investigators reported that the patient is receiving palliative care because of deterioration of his condition systemically.

Dr Pestano reported, “In a case with no metastasis, physicians are advised to remember the possibility of an infiltrative neuropathy that is masquerading as another pathology. The most common metastatic tumours to the optic nerve are adenocarcinomas such as the one in this case.”