[A 44-year-old patient with cardial carcinoma and paraneoplastic orbital disease]

Bilateral orbital involvement with chemosis, protrusion and reduced vision developed in a 44-year-old man 12 weeks after carcinoma of the cardia with lymph node metastases and peritoneal carcinomatosis had been diagnosed and palliative chemotherapy with a cycle of leucovorin and 5-fluorouracil had been concluded.

Computed tomography excluded a retrobulbar metastasis. Thyroid hormone concentration was normal as was the thyroid autoantibody titre. There was also no evidence on sonography of endocrine orbital disease. These findings established the diagnosis of paraneoplastic orbital myositis.

The symptoms briefly regressed on initial treatment with systemically administered high doses of corticosteroids. Renewed marked eyeball protrusion with incipient visual loss was treated with conjunctival drainage and tarsorrhaphy, as well as radiotherapy to the retrobulbar space. This achieved significant improvement. Shortly thereafter the patients died of acute bleeding from the primary tumour.

In patients with an underlying malignancy and symptoms of orbital myositis orbital involvement as part of a paraneoplastic syndrome should be diagnosed once other causes have been excluded.