Orbital Metastasis From Urothelial Carcinoma: A Comprehensive Literature Review

Abstract

Purpose: To review the clinical features of orbital and choroidal metastases from urothelial carcinomas of the urinary tract among cases reported in the literature, and to describe a case of orbital metastasis from bladder cancer presenting as apparent internuclear ophthalmoplegia. Methods: Case reports of orbital and choroidal metastases from urothelial carcinomas published in the literature from 1965 to 2018 were reviewed. Data collected included patient demographics, cancer stage and primary site, time to onset of ocular symptoms, length of presenting ocular symptoms, types of primary ocular symptoms, diagnostic imaging, histology, systemic and ocular treatments, and survival time. Results: Twenty-eight cases of urothelial carcinoma with metastasis to the orbit or choroid were reviewed. Men were significantly more likely to suffer from this condition than women (p = 0.011). The average age of presentation with orbital symptoms was 63 years, with an average time of 19 months between primary cancer diagnosis and onset of orbital symptoms. Twenty-two patients had metastasis to the orbit and 6 to the choroid. In 4 cases, ocular deficits secondary to orbital and/or choroidal metastases were the initial presenting symptoms in patients with previously undiagnosed urothelial carcinoma. The most commonly noted primary ocular symptoms and signs consisted of decreased visual acuity, decreased ocular motility, proptosis, and diplopia. Average survival from onset of ocular symptoms was 4.67 months. Conclusions: Urothelial carcinoma may metastasize to the orbit or choroid; furthermore, its presentation may mimic internuclear ophthalmoplegia. It is recommended that any patient with visual symptoms and known urothelial cancer should undergo expedited workup for metastatic disease.

Clinical and Imaging Characteristics of Metastatic Orbital Tumours in North China

“…Orbital metastases are rare, and previous studies have reported that orbital metastases represent approximately 3∼7% of all orbital space-occupying lesions [2,3]. Ophthalmologists play an important role in the diagnosis of orbital metastasis; 19% to 25% of patients may have no history of systemic cancer when presenting with ophthalmic symptoms [4]. Malignant tumours generally metastasize via the haematogenous route to the orbit [5].…”

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

“…There is a limited number of individual studies on orbital metastases, and feasible therapeutic options are still debated [ 14 , 15 ]. In this systematic review, we evaluate the clinical features and management strategies of patients with orbital metastases, focusing on factors related to symptom improvement and survival.…”

Skin nodules and proptosis in a case of carcinoma urinary bladder

“…[ 2 ] Orbital metastases are also uncommon, accounting for 2.5%–8.1% of all the orbital space-occupying lesions. [ 3 ] Diminished vision, proptosis, decrease in mobility, and double vision are the most common manifestations of orbital metastases. This case highlights the unusual physical manifestations of the underlying urological malignancy.…”