Metastatic pancreatic carcinoma to the orbital apex presenting as a superior divisional third cranial nerve palsy

Abstract

Metastatic tumors to the orbit are rare, especially from a primary pancreatic carcinoma. A 59-year-old man presented with 4 weeks of right eye pain and eyelid swelling. There was right upper eyelid ptosis associated with a right supraduction deficit consistent with a superior divisional third cranial nerve (CN III) palsy. Magnetic resonance imaging revealed a right orbital apex lesion. A right orbital exenteration was performed for intractable and severe pain. Surgical pathology demonstrated a poorly differentiated carcinoma that was ultimately felt to be derived from the pancreas. In this report, we describe the clinical and neurological imaging findings of a superior divisional CN III palsy as the presenting manifestation of a presumed metastatic pancreatic carcinoma to the orbital apex, and review the neuroanatomy of CN III with particular emphasis on the anatomical bifurcation of the nerve into a superior and inferior division.

Keywords:

• orbital tumor
• orbital metastasis
• superior division
• third cranial nerve palsy

Acknowledgements

We thank the patient and his family for contributing to this report. This report was supported by a 2011–2012 Duke University unrestricted departmental grant from Research to Prevent Blindness. NAR, MJR, and MTB contributed substantially to the collection of patient information, consent, and treatment. PEP and MTB contributed substantially to drafting the article and revising it critically for important intellectual content. All authors contributed to the final approval of the version to be published.

Disclosure

The authors report no conflicts of interest in this work.