Fenton S, Kemp E G, Harnett A N
The Ocular Oncology Unit, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
Eye (Lond). 2004 Jan;18(1):38-40. doi: 10.1038/sj.eye.6700535.
Breast carcinoma metastasises to the eye more frequently than is clinically recognised. The incidence is perhaps not appreciated, either because of the more common involvement and consequences of spread to major organs (such as lung, liver, or bone) or because a number of eye lesions are small and asymptomatic. Over a 6-month period, all patients with locally advanced or metastatic breast cancer were screened for ocular involvement and as a result management recommendations made.
Between January 2001 and June 2001, 68 patients with known locally advanced or metastatic breast carcinoma were referred for a screening ophthalmic examination. The aim of the study was to assess the frequency of asymptomatic ocular metastases by breast carcinoma in visually asymptomatic patients. The recognition and early treatment of both ocular metastases and ocular manifestations of metastatic breast carcinoma are important in maximising the quality of life in this group of palliative patients. These patients were all referred and recruited from the Beatson Oncology Centre and Breast Unit at the Western Infirmary, Glasgow by the oncologist (ANH). Examination included visual acuity assessment, slit-lamp examination, tonometry, and indirect ophthalmoscopy.
The median time from diagnosis of breast carcinoma to ophthalmic screening was 5 years (range 6 months-23 years). No patient had any evidence of choroidal metastases on ophthalmic examination. Four patients (5.8%) had ophthalmic manifestations of metastatic breast carcinoma and a further two had ocular complications of treatment. One patient had a restrictive motility problem from a metastatic deposit to her lateral rectus muscle and another had corneal punctate epitheliopathy secondary to a seventh nerve palsy. A further patient had coarse nystagmus from cerebellar metastases and the final patient of the four had a Horner's syndrome from metastases in the neck. In addition, two patients had symptomatic dry eyes whose onset coincided with commencement of chemotherapy.
Ophthalmic manifestations of metastatic breast carcinoma occurred in 5.8% of asymptomatic patients. Orbital metastases were documented in one patient. No case of choroidal metastases was observed in this group with advanced or metastatic disease. Therefore, patients do not need to be routinely screened particularly for choroidal metastases.
乳腺癌转移至眼部的情况比临床认识到的更为常见。其发病率可能未得到充分认识，这要么是因为转移至主要器官（如肺、肝或骨）更为常见且后果更为严重，要么是因为一些眼部病变较小且无症状。在6个月的时间里，对所有局部晚期或转移性乳腺癌患者进行了眼部受累情况筛查，并据此提出了管理建议。
2001年1月至2001年6月期间，68例已知局部晚期或转移性乳腺癌患者被转诊进行眼科筛查。本研究的目的是评估在视觉无症状患者中乳腺癌无症状眼部转移的频率。识别并早期治疗眼部转移以及转移性乳腺癌的眼部表现对于最大化这组姑息治疗患者的生活质量很重要。这些患者均由肿瘤学家（ANH）从格拉斯哥西部医院的 Beatson 肿瘤中心和乳腺科转诊并招募。检查包括视力评估、裂隙灯检查、眼压测量和间接检眼镜检查。
从乳腺癌诊断到眼科筛查的中位时间为5年（范围6个月至23年）。眼科检查中没有患者有脉络膜转移的任何证据。4例患者（5.8%）有转移性乳腺癌的眼部表现，另外2例有治疗的眼部并发症。1例患者因转移瘤累及外直肌出现限制性眼球运动问题，另1例因第七神经麻痹继发角膜点状上皮病变。另有1例患者因小脑转移出现粗大眼球震颤，这4例中的最后1例因颈部转移出现霍纳综合征。此外，2例患者出现有症状的干眼，其发病与化疗开始时间一致。
5.8%的无症状患者出现转移性乳腺癌的眼部表现。1例患者记录有眼眶转移。在这组晚期或转移性疾病患者中未观察到脉络膜转移病例。因此，患者无需常规进行特别是脉络膜转移的筛查。
