A rare case of Superior Orbital Fissure Syndrome secondary to metastatic Prostatic Carcinoma

Superior Orbital Fissure syndrome is an infrequently described symptom complex presenting as ptosis of the upper eye lid, proptosis of the globe, ophthalmoplegia, fixation and dilatation of the pupil, and anaesthesia of the upper eyelid and forehead. We present a case of a 56 year old male presenting with recent onset dropping of the left upper eye lid. On eliciting detailed history, the patient revealed to be a known case of Prostatic Carcinoma on treatment at a cancer care centre. On clinical examination, the left eye showed exotropia and limitation of all the extraocular movements, suggesting an involvement of 3rd and 6th Cranial nerves. This indicated the likely site of lesion at the Superior Orbital Fissure. Imaging confirmed the above and the Superior Orbital Fissure syndrome was seen to be secondary to extensive intracranial metastasis from prostatic carcinoma. Extensive skeletal metastasis were also seen to be involving the chest, abdomen and pelvic bones. The patient was subsequently referred to a tertiary cancer care centre for treatment. Prostatic carcinoma is extremely rarely seen to present with cranial nerve palsies and no other case of Prostatic Carcinoma presenting as Superior Orbital Fissure was found in literature. This case highlights the importance of a thorough history and evaluation of neurological symptoms in cases presenting with cranial nerve palsies. Also, investigations like contrast CT and PSA levels can help rule out sinister underlying causes of these symptoms