Multimodal imaging evaluation and management of orbital metastasis: experience at a single institution

The orbit is an unusual site for metastatic cancer. This study evaluated the ultrasonographic and MRI/CT imaging features of orbital metastasis (OM) as well as demographic, clinical, radiological, management, and outcome.

Retrospective, non-comparative single-institutional chart review of patients with OM. Records were evaluated for age at presentation, race, gender, laterality, site of primary tumor, imaging findings of orbital metastasis, treatment, and outcome.

There were 12 males and 15 females whose mean age at presentation was 60 years. Twenty-three patients (85%) had known primary cancer. Primary malignancies were breast carcinoma in 12 patients (44.5%), melanoma in 5 (18.5%), and lung carcinoma in 3 (11.1%). The most present findings were ocular motility disturbances (63%), proptosis (55%), and vision loss (19%). The lesions were well-outlined in 74%, located posterior to the equator in 59%, involved only one quadrant in 56%, and involved the extraocular muscles in 74%. Ultrasound was able to detect orbital or muscle lesions in 24 patients (89%). The shape, configuration, and location of the lesion and detection of extraocular muscle involvement agreed between MRI/CT and US exams. Treatment protocols included radiotherapy, chemotherapy, immunotherapy, hormone therapy and surgical excision. Seventeen patients (63%) had died of metastasis, with a mean overall survival time of 19 months after OM diagnosis.

Breast carcinoma, melanoma, and lung carcinoma are the most common primary malignancies that metastasize to the orbit. OM tends to infiltrate the extraocular muscles. Ultrasound provides reliable parameters and can be used as a primary screening when evaluating suspected OM lesions. The survival time of patients with OM is generally poor.