Nasopharyngeal Malignancy Presenting as Proptosis in Children

Abstract

Nasopharyngeal malignancy is potentially devastating with a high mortality especially if there is delay in diagnosis or late presentation. Nasopharyngeal carcinoma (NPC) presenting with proptosis as a major symptom to an Ophthalmologist is uncommon especially in the paediatric age group. It is against this background we present these patients to share our experience. We retrospectively reviewed cases of nasopharyngeal cancer in children who first presented to the Ophthalmologist at the Olabisi Onabanjo University Teaching Hospital [OOUTH] Sagamu between 2008 and 2010.
Three paediatric patients presented at the eye clinic of OOUTH Sagamu. Two of the patients presented with severe uniocular proptosis and the third with bilateral proptosis. The patients also developed reduced hearing, epistaxis, severe and disturbing headache and neck swelling. There was profound vision loss in three eyes of the three patients. Their eyeballs showed restricted ocular movements. Radiological imaging showed features suggestive of nasopharyngeal cancer involving the nasopharynx, sinuses and orbit. One had Fine Needle Aspiration Cytology [FNAC] from the cervical gland confirmatory of Burkitt's lymphoma. The other two cases were worked up for biopsy from the nasopharynx but discharged against medical advice. The patient with bilateral proptosis died shortly after. The ophthalmologist may bethe first to be consulted in cases of a nasopharyngeal cancer with ophthalmic manifestation. Diagnosis is usually difficult to make except with a high index of suspicion. For this reason it is imperative for the ophthalmologist to be familiar with this subject matter.

Key words: Proptosis, nasopharyngeal malignancy, ocular presentation, children