Abstract：
We report a patient with isolated ptosis secondary to orbital metastasis but no evidence of a neoplastic process on magnetic resonance imaging (MRI). A 69-year-old male was referred to our hospital with ptosis of the right upper eyelid and secondary frontalis muscle overaction on the left side for six months. The palpebral fissure was 3mm on the right and 16mm on the left, and levator function was 6mm and 19mm respectively. Three years previously, he had undergone surgical resection of the left lower lobe of the lung due to a T1 N0 M0 adenocarcinoma, and no recurrence had since been observed. An MRI was performed to rule out ptosis secondary to metastasis. Thyroid dysfunction and myasthenia were also ruled out. The ptosis was attributed to an isolated microvascular third nerve palsy. A standard external levator advancement was performed. Six months after the surgery, the patient presented with intense pain, minimal ptosis, edema and diplopia. A new MRI revealed an orbital metastasis measuring 2.4×1.0×1.6cm in the superior orbit, exerting mass effect on the superior rectus and the levator palpebrae superioris muscle. A positron emission tomography scan revealed a recurrence of the lung cancer with multiple bony metastases. The patient underwent chemotherapy consisting of the taxol-carboplatin protocol. Our report highlights the importance of a high index of suspicion of a neoplastic etiology in patients with mild symptoms and a history of cancer even if imaging does not initially reveal a mass or infiltration.
摘要：
我们报告了一名继发于眼眶转移的孤立性下垂患者，但在磁共振成像（MRI）上没有肿瘤形成过程的证据。一名69岁的男性因右上眼睑下垂和左侧继发性额肌过度活动六个月而被转诊到我院。睑裂右侧3mm,左侧16mm,和提肌功能分别为6mm和19mm。三年前,由于T1N0M0腺癌，他接受了左下叶的手术切除，此后没有观察到复发。进行MRI以排除继发于转移的下垂。甲状腺功能障碍和肌无力也被排除。上睑下垂归因于孤立的微血管第三神经麻痹。进行了标准的外部提肌前移。手术后六个月,病人表现出强烈的疼痛，最小上睑下垂,水肿和复视。新的MRI显示上眶有2.4×1.0×1.6cm的眼眶转移，对上直肌和提上掌肌施加质量作用。正电子发射断层扫描显示肺癌复发并伴有多个骨转移。患者接受了由紫杉醇-卡铂方案组成的化疗。我们的报告强调了即使影像学最初未发现肿块或浸润，在症状轻微且有癌症史的患者中，高度怀疑肿瘤病因的重要性。
