Exophthalmos is most often associated with autoimmune thyroid disease, particularly Graves disease. Paraneoplastic syndromes rarely manifest as orbital inflammation, and only a few cases have been described in association with solid tumors. We present a case of a 67‐year‐old male diagnosed with esophageal cancer. Shortly after diagnosis, he developed rapidly progressive bilateral exophthalmos with ophthalmoplegia. Thyroid function and thyroid‐stimulating immunoglobulin were normal, and MRI orbits demonstrated enlargement of extraocular muscles with apical crowding, consistent with inflammatory orbitopathy. Given the absence of thyroid disease, a paraneoplastic process was suspected. The patient was treated with prednisone 60 mg daily, tapered over 5 weeks, resulting in complete resolution of symptoms within 2 weeks. He underwent chemoradiation with interval improvement in the primary tumor. Several months later, disease progression occurred with new mediastinal and iliac lymphadenopathy, coinciding with recurrence of exophthalmos. A second course of corticosteroids again resulted in full remission of the orbital findings. This case highlights paraneoplastic exophthalmos as a rare manifestation of esophageal adenocarcinoma. The temporal association between tumor activity and orbital inflammation, coupled with steroid responsiveness, supports an immune‐mediated mechanism. Recognition of this phenomenon is important to avoid misdiagnosis and to guide prompt corticosteroid therapy and oncologic management. In summary, exophthalmos is a very rare paraneoplastic finding. Workup needs to include brain imaging to exclude direct metastasis to the retro‐orbital space. Immediate treatment for neoplastic disease is likely to resolve symptoms. High‐dose steroids are effective in relieving symptoms.
Tovar et al. (Thu,) studied this question.