HORNER'S-TRIAS AND DIPLOPIA AS FIRST SYMPTOMS OF A BRONCHIAL CARCINOMA

97th DOG Annual Meeting 1999

P507
HORNER'S-TRIAS AND DIPLOPIA AS FIRST SYMPTOMS OF A BRONCHIAL CARCINOMA

I. M. Velten, G. C. Gusek-Schneider

Background: In about 30% of patients with orbital metastases, these metastases are detected before the primary tumour is known. Less than 5% of orbital metastases are located in extraocular muscles. We report on a patient with peripheral Horner's trias and diminished abduction of the left eye as first symptoms of a bronchogenic carcinoma.

Patient: A 86-year-old patient presented with a newly developed diplopia. On examination, the left eye showed a diminished abduction, ptosis and miosis. Pharmacological testing revealed a peripheral Horner's syndrome. A chest X-ray showed a huge tumour in the upper lobe of the left lung with multiple metastases to the lungs. On cranial magnet resonance tomogaphy, the lateral rectus muscle belly was enlarged, suspicious for metastasis. Further examinations revealed a large cell bronchogenic carcinoma with metastases to the lungs, adrenal glands, and the left lateral rectus muscle.

Conclusions: The combination of a peripheral Horner's trias with diminished abduction of the homolateral eye primarily suggests a lesion in the cavernous sinus. This combination of deficits caused by metastases of a bronchogenic carinoma is rare. In each patient with newly developed peripheral Horner's syndrome, especially when combined with other alterations, apart from an ophthalmological examination, a neurological and physical examination should be performed, and detailed radiographic or magnetic resonance tomographic evaluation should be conducted to find out or to exclude neoplasia.

Augenklinik mit Polinik der Universität Erlangen-Nürnberg, Erlangen, Schwabachanlage 6, D-91054 Erlangen

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