Exophthalmos and Blindness as the Initial Manifestations of Metastatic Lung Cancer: A Case Report

Orbital metastasis is a rare manifestation of lung cancer and may occasionally be the first sign of an underlying malignancy. We report the case of a 49-year-old man who presented with acute right-sided exophthalmos, ptosis, and complete visual loss, along with respiratory symptoms that had progressed over several months, including chronic cough and general deterioration. Brain and orbital computed tomography (CT) revealed an osteolytic mass involving the right sphenoid sinus, with intracranial extension and involvement of the optic canal. Chest CT demonstrated a large right upper lobe mass causing bronchial obstruction, with associated mediastinal and hilar lymphadenopathy. Bronchoscopy with bronchial biopsies confirmed lung adenocarcinoma, and the orbital lesion was highly suggestive of metastasis based on the clinical and radiological findings. Given the advanced disease, complete visual loss, and poor general condition, palliative treatment was chosen following a multidisciplinary tumor board discussion. Three months after diagnosis, the patient died following further clinical deterioration.