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array:24 [ "pii" => "S2173579419301409" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.07.003" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1546" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:510-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669119302266" "issn" => "03656691" "doi" => "10.1016/j.oftal.2019.07.003" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1546" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:510-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 41 "formatos" => array:2 [ "HTML" => 33 "PDF" => 8 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Exoftalmos unilateral secundario a metástasis en músculo recto interno de adenocarcinoma de esófago" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "510" "paginaFinal" => "513" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Unilateral exophthalmos secondary to esophageal adenocarcinoma metastasis to the medial rectus muscle" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 556 "Ancho" => 1305 "Tamanyo" => 78287 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tomografía axial computarizada con y sin contraste que objetiva una masa izquierda intra- y extraconal que engloba al músculo recto interno: corte coronal.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "K. 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"apellidos" => "Burgueño Montanés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579419301409" "doi" => "10.1016/j.oftale.2019.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419301409?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119302266?idApp=UINPBA00004N" "url" => "/03656691/0000009400000010/v2_202112310746/S0365669119302266/v2_202112310746/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579419301021" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.04.006" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1512" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:514-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Lower eyelid reconstruction with pericranium graft and Mustarde flap" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "517" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de párpado inferior mediante injerto de pericráneo y colgajo de Mustardé" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 802 "Ancho" => 1255 "Tamanyo" => 225384 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a) Preoperative photograph. (b) The tumoration is composed of an epithelial basaloid cells proliferation which forms nests infiltrating a markedly desmoplastic stroma (HE 100×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Ibáñez-Flores, C. Bruzual-Lezama, J.J. Castellar-Cerpa, L. Fernández-Montalvo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Ibáñez-Flores" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Bruzual-Lezama" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Castellar-Cerpa" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Fernández-Montalvo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669119301285" "doi" => "10.1016/j.oftal.2019.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119301285?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419301021?idApp=UINPBA00004N" "url" => "/21735794/0000009400000010/v1_201910010751/S2173579419301021/v1_201910010751/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579419301215" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.05.007" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "1521" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:504-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Amniotic membrane in the surgical treatment of post-blepharoplasty diplopia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "504" "paginaFinal" => "509" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Membrana amniótica en el tratamiento quirúrgico de diplopía posblefaroplastia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2198 "Ancho" => 2928 "Tamanyo" => 386753 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sagittal section of eyelid, ocular globe and inferior and anterior region of the orbit, showing the proximity of the medial fat package with the inferior oblique, inferior rectus muscles and the Lockwood ligament. Original illustration by Dr. Héctor Fernández Jiménez-Ortiz.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H. Fernández Jiménez-Ortiz, R. Gómez de Liaño Sánchez, S. Navas Pérez, I. Genol Saavedra, N. Toledano Fernández" "autores" => array:5 [ 0 => array:2 [ "nombre" => "H." "apellidos" => "Fernández Jiménez-Ortiz" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Gómez de Liaño Sánchez" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Navas Pérez" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Genol Saavedra" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Toledano Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669119301546" "doi" => "10.1016/j.oftal.2019.05.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119301546?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419301215?idApp=UINPBA00004N" "url" => "/21735794/0000009400000010/v1_201910010751/S2173579419301215/v1_201910010751/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Unilateral exophthalmos secondary to esophageal adenocarcinoma metastasis to the medial rectus muscle" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "510" "paginaFinal" => "513" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "K. Fernández Berdasco, L. Fernández Díaz, P. Jiménez-Fonseca, J. Calvo Blanco, C. Burgueño Montanés" "autores" => array:5 [ 0 => array:4 [ "nombre" => "K." "apellidos" => "Fernández Berdasco" "email" => array:1 [ 0 => "karinafdezb@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Fernández Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Jiménez-Fonseca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Calvo Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Burgueño Montanés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Oncología Médica, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author:" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exoftalmos unilateral secundario a metástasis en músculo recto interno de adenocarcinoma de esófago" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 953 "Ancho" => 1405 "Tamanyo" => 138897 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Computerized axial tomography with and without contrast, showing an intra-and extraconal left mass surrounding the internal rectus muscle: cross-section.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Compared to other reasons for ophthalmological consultations, remote metastases from a located primary tumor are an infrequent finding (1–13% of orbital tumor pathology).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> In over 35% of cases, orbital metastasis diagnostic precedes that of the primary tumor and therefore the ophthalmologist could play a crucial role in the prognosis of these patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male, 51, former smoker, obese, diagnosed since 2015 with stage IV distal oesophagusadenocarcinoma, diffuse Lauren type with signet ring cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The disease exhibited ganglion and peritoneal metastases as well as severe locoregional extension, infiltrating adjacent structures and larger vessels with significant response to first chemotherapy line sustained during 3 years and weekly placlitaxel treatment upon progression. The patient was referred from medical oncology for urgent ophthalmological assessment due to left eye unilateral exophthalmos with 2 weeks evolution in progression in addition to binocular diplopia and visual acuity loss. The only remarkable ophthalmological history was left eye amblyopia with visual acuity under 0.1.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Patient examination showed marked left unilateral exophthalmos together with significant motility limitation in all gaze positions, predominantly in levoduction (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Slit lamp examination showed episcleral hyperemia and superficial dotted keratopathy. Visual acuity was 1.0 in the right eye and finger counting in the left eye. Intraocular pressure was normal in both eyes and ocular fundus did not show anomalies.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Suspecting orbital metastases or carotid-cavernous fistula probably related to the underlying neoplastic process, an urgent cranial computerized action tomography was taken which evidenced a poly-lobulated and heterogeneous intra-and extraconal left orbital mass surrounding the internal rectus muscle. The finding was compatible with metastasis in addition to another small extraconal mass at the base of the contralateral orbit (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Accordingly, the patient was referred back to medical oncology for assessment and expressed his desire for outpatient treatment. A medical-patient agreement was reached to refer the patient to follow-up by the home palliative care unit due to progression up to 2 chemotherapy lines with rapid deterioration of the patient’s general condition in recent weeks. Respecting the patient’s wish and for ethical reasons the histological confirmation of the mass was not carried out. Analgesic treatment was indicated with palliative radiotherapy. The patient died 2 weeks after being diagnosed with said orbital metastasis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Orbital metastases are less frequent than ocular metastasis and more frequently involve the lateral and superior part of the orbit. The most frequent inception in adults is breast cancer (40–60%), followed by lung and kidney cancer and melanoma, although in 10–19% of cases inception is not identified. In contrast to what could be expected, only 10% of cases exhibit bilateral presentation. Very few reports have been found in the literature associating oesophagus cancer as primary origin of orbital metastasis,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–10</span></a> with extraocular musculature compromise being even less frequent. Metastases originating in adenocarcinoma as well as oesophagus squamous carcinoma have been described. Oesophagus adenocarcinoma with signet rings cells is an infrequent histological type that courses with poorer prognosis and response to treatment. A comprehensive bibliographic search did not find any other case of orbital metastases secondary to oesophagus carcinoma with signet rings cells.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The most common and earliest signs of orbital metastases include ocular globe proptosis and ocular motility impairment, although diminished visual acuity, ocular pain, palpebral ptosis could arise as well as funduscopic alterations such as retinal folds and papillary edema. In what concerns diagnosis, nuclear magnetic resonance and computerized axial tomography are essential and more useful than echography. In some cases, biopsy is useful for confirming the pathological diagnostic although the procedure is not feasible for all patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In computerized axial tomography, orbital metastases exhibit a density similar to that of the extraocular musculature. When muscles are impaired, it is generally due to a solitary mess with uneven edges that could also involve bone destruction with or without intracranial invasion and typically contrast-capturing.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Orbital metastasis management depends on the nature of the primary tumor and can range from chemotherapy, decompressive surgery up to simple observation, with radiotherapy being essential for managing symptoms and recovering vision. Said metastases have a mean survival of 15 months and generally course with negative prognosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Accordingly, the main objective of treatment is to improve the quality of life and visual function of patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Metastases in extraocular muscles are a very infrequent finding that must be suspected in the presence of unilateral exophthalmos, referring the patient if necessary for imaging and/or other supplementary tests. In up to one third of cases it could be the first expression of undiagnosed neoplasia, and for this reason the ophthalmologist could play a crucial role in the prognosis of these patients. In the present case, the extension of the tumor and survival over 3 years in a cancer type with a mean overall expected survival rate of 9–11 months could contribute to the extension of the tumor to extraocular muscles.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">No conflict of interest was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1250897" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1159784" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1250896" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1159785" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-15" "fechaAceptado" => "2019-07-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1159784" "palabras" => array:3 [ 0 => "Orbital metastasis" 1 => "Oesophageal cancer" 2 => "Diplopia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1159785" "palabras" => array:3 [ 0 => "Metástasis orbitaria" 1 => "Cáncer de esófago" 2 => "Diplopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A case is presented on a 51-year-old man with stage IV oesophageal adenocarcinoma. The patient was referred by the Oncology Department urgently for a same-day assessment by an ophthalmologist due to two weeks of severe unilateral exophthalmos and binocular diplopia. A comprehensive eye exam revealed the presence of an axial non-reductive exophthalmos and a limitation in left eye levoduction. A computed tomography scan was performed that showed a multiple lobed, intra- and extra-conal, heterogeneous left orbital mass, that surrounded the internal rectus muscle, compatible with metastasis, as well as another small extraconal mass at the base of the contralateral orbit. Palliative radiotherapy was then indicated. Metastases in the extraocular muscles are a very rare finding, but should be suspected in a case of unilateral exophthalmos and, if necessary, refer the patient to have the corresponding complementary tests performed.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Varón de 51 años con diagnóstico de adenocarcinoma de esófago estadio IV. Es referido desde oncología médica para valoración oftalmológica urgente por llamativo exoftalmos izquierdo de dos semanas de evolución además de diplopía binocular. En la exploración oftalmológica destaca la presencia de un exoftalmos axial no reductible y una limitación de la motilidad ocular a la levoducción. Se realiza una tomografía axial computarizada craneal urgente donde se objetiva una masa orbitaria izquierda polilobulada y heterogénea, intra y extraconal, que engloba al músculo recto interno, compatible con metástasis, además de otra pequeña masa extraconal en la base la órbita contralateral. Se indica entonces tratamiento con radioterapia paliativa. Las metástasis en los músculos extraoculares son un hallazgo muy poco frecuente, pero deben sospecharse ante un caso de exoftalmos unilateral y, de ser necesario, remitir al paciente para realizar las pruebas complementarias correspondientes.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández Berdasco K, Fernández Díaz L, Jiménez-Fonseca P, Calvo Blanco J, Burgueño Montanés C. Exoftalmos unilateral secundario a metástasis en músculo recto interno de adenocarcinoma de esófago. Archivos de la Sociedad Española de Oftalmología. 2019. <span class="elsevierStyleInterRef" id="intr9005" href="https://doi.org/10.1016/j.oftal.2019.07.003">https://doi.org/10.1016/j.oftal.2019.07.003</span></p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1358 "Ancho" => 2375 "Tamanyo" => 307796 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Left exophthalmos with motility limitation in all gaze positions.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 953 "Ancho" => 1405 "Tamanyo" => 138897 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Computerized axial tomography with and without contrast, showing an intra-and extraconal left mass surrounding the internal rectus muscle: cross-section.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 556 "Ancho" => 1305 "Tamanyo" => 78306 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Computerized axial tomography with and without contrast, showing an intra-and extraconal left mass surrounding the internal rectus muscle: coronal section.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An analysis of 2,480 space-occupying lesions of the orbit from 1976 to 2011" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. 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