Nasopharyngeal carcinoma with orbital involvement.

PURPOSE: To describe the clinical presentation of patients with nasopharyngeal carcinoma and orbital involvement.

METHODS

A retrospective case series of 9 patients with nasopharyngeal carcinoma presenting with orbital involvement from March 2003 to April 2006 at the Singapore National Eye Centre were reviewed. The clinical profile, neuroradiologic evaluation, and clinical course of these patients were reviewed.

RESULTS

There were 3 women and 6 men with stage T4 disease. The mean age was 49.2 years +/- 7.69 years (range, 37-57 years). The mean time from initial diagnosis of nasopharyngeal carcinoma to orbital involvement was 8.2 years (range, 0.8-29 years). One patient had no prior history of nasopharyngeal carcinoma. Four patients presented with an eyelid mass and 2 patients reported tearing. Other symptoms included diplopia, blurred vision, and protrusion of the eye. Imaging revealed tumor involvement of the orbital apex, inferior orbital fissures with intraconal spread, and infiltration of the lacrimal sac. The recurrences were confirmed histologically. Patients were treated with radiotherapy and/or chemotherapy. There were 3 deaths from advanced nasopharyngeal carcinoma during the follow-up period. The time interval from diagnosis of orbital involvement to death ranged from 8 months to 24 months.

CONCLUSION

Ocular symptoms and signs may be the initial presentation of recurrent nasopharyngeal carcinoma. One must therefore be aware of possible tumor recurrence in patients with a prior history of nasopharyngeal carcinoma who present with symptoms of tearing or an eyelid mass, as this would enable prompt referral to the oncologist and otorhinolaryngologist.