Orbital Decompression as Palliative Management of Metastatic Adenocarcinoma of the Colon: A Case Report

Colorectal cancer (CRC) is one of the most prevalent malignancies in Canada and in the world. Orbital metastases of colorectal origin, however, are rare and standard management options have not been determined. A 72-year-old man presented with proptosis of the right eye, diplopia and elevated intraocular pressure. An orbital mass of colonic adenocarcinoma origin was diagnosed which localized to the right greater wing of the sphenoid. The mass caused progressive proptosis, a decline in visual acuity, and a right relative afferent pupillary defect (RAPD). The patient had a history of metastatic colon cancer starting 17 years prior with surgical management of liver and hip metastases as well as radiation therapy to the right hip and right orbit. With the patient’s consent and understanding that it was not an oncologic procedure, palliative orbital decompression was performed to slow the mass effects on his visual system. Upon follow-up, the patient reported improvement of visual symptoms. Orbital metastasis from colon adenocarcinoma is rare, with only 10 reported cases in the literature. To our knowledge, this is the first report of orbital decompression as a palliative treatment for orbital metastasis from colonic adenocarcinoma resulting in patient-reported alleviation of mass-effect symptoms. The clinical impact of this report is to provide evidence of orbital decompression as a possible palliative treatment for similar cases.