Walsh & Hoyt: Orbital Metastases

Shields reviewed 100 cases of orbital metastases from a quarter century at Wills Eye Hospital and found breast cancer as the primary in 53% of patients, prostate in 12%, lung in 8%, and melanoma in 6%. When the lesion affects the optic nerve, the patient may experience acute or slowly progressive loss of vision in one eye and thus may be thought initially to be suffering from optic neuritis or ischemic optic neuropathy. In other cases, slowly progressive loss of vision may suggest a primary compressive lesion, such as a meningioma or pituitary adenoma. Malignant tumors elsewhere in the body rarely may metastasize to primary optic nerve tumors. Arnold reported the case of a 71-year-old woman in whom adenocarcinoma of the lung metastasized to a primary optic nerve sheath meningioma. This is a rare event.