Back to Journals » Clinical Ophthalmology » Volume 6

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

Authors Pecen P, Ramey, Richard, Bhatti

Received 26 January 2012

Accepted for publication 27 February 2012

Published 23 November 2012 Volume 2012:6 Pages 1941—1943


Review by Single anonymous peer review

Peer reviewer comments 2

Paula E Pecen,1 Nicholas A Ramey,1 Michael J Richard,1 M Tariq Bhatti1,2

Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA; 2Department of Medicine (Division of Neurology), Duke University Medical Center, Durham, NC, USA

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

Creative Commons License © 2012 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.