Ophthalmo-neurologic manifestation of nasopharyngeal carcinoma

Ophthalmo-neurologic manifestations may be the first and sole presenting feature of nasopharyngeal carcinoma. This may be mis-leading unless a high index of suspicion exists. A retrospective study with analysis of 79 patients with nasopharyngeal carcinoma seen in the 12 years between 1986 and 1997 is presented. Among the 79 cases seen and analysed 20 (25%) had ophthalmo-neurologic manifestations; showing that up to one quarter of nasopharyngeal carcinoma cases could have neuro-ophthalmic manifestations. The ages ranged between 11 years and 70 years with a male: female ratio 2.4:1. This is in consonance with previous reports that nasopharyngeal carcinoma mostly affects males. In this study, visual impairment and corresponding optic nerve lesions constituted 20% of the manifestations. Diplopia and ophthalmoplegia constituted 17% and 18% respectively of the manifestations; these are in consonance with previous reports as seen in literatures. However ptosis (15%) and Horner's syndrome (3%) were essential manifestations seen in this study that were not found or documented in other previous reports. It shows that these could be part of neuro-ophthalmic manifestations of malignant nasopharyngeal carcinoma prompting patients initial presentation to the ophthalmologist. This paper is thus to draw more attention to the significance of ophthalmo-neurologic signs and symptoms as an aid to early diagnosis of malignant nasopharyngeal carcinoma. This will no doubt improve prognosis.