“Tag-Team” Orbital and Strabismus Surgeries with Immediate Reconstruction After Tumor Excision Metastatic to the Inferior Rectus

Abstract

Carcinoid tumors are rare, slow-growing, low-grade neuroendocrine tumors with a propensity for orbital metastatic spread. The typical treatment paradigm for localized orbital disease involves excision, adjuvant radiotherapy, and/or receptor-targeted chemotherapy, followed by delayed evaluation for reconstructive strabismus surgery. We present a 58-year-old female patient with carcinoid tumor metastatic to the right inferior rectus muscle who presented with worsening binocular diplopia. The patient underwent coordinated "tag-team" orbital and strabismus surgeries that included excision of the right inferior rectus muscle to the annulus of Zinn followed immediately by reconstructive strabismus surgery. The patient required 1 additional strabismus surgery 1 year later. Follow up revealed no tumor recurrence at 4 years, and excellent binocular vision with good function. Deep orbital and strabismus surgeries, when performed simultaneously in a "tag-team" approach, may offer superior functional outcomes and improved patient quality of life, with expedited functional recovery. This approach may become a new treatment paradigm for surgical disease processes localized to the extraocular muscles.

Multispecialty Management of Metastatic Colon Adenocarcinoma Involving the Extraocular Muscles: Primary Excision and Simultaneous Treatment of Strabismus With a Review of the Literature

“…This provides a significant benefit in the treatment of extraocular muscle tumors as it allows for the preservation of surgical planes that facilitate muscle surgery, leading to better long-term outcomes and faster functional recovery. 9 In both our case and that reported by Wu, the patients had resolution of their diplopic symptoms and quick visual rehabilitation. This simultaneous multispecialty approach may emerge as a novel treatment paradigm for similar cases involving the extraocular muscles.…”

“…To provide rapid and complete symptomatic relief, the patient underwent simultaneous strabismus repair with transposition of the superior and inferior recti muscles. This multispecialty approach has been previously reported for a different case involving a metastatic carcinoid tumor to the inferior rectus muscle by Wu et al 9 The concurrent execution of deep orbital and strabismus surgeries in a collaborative "tag-team" manner potentially yields enhanced functional outcomes and improves patients' quality of life. This provides a significant benefit in the treatment of extraocular muscle tumors as it allows for the preservation of surgical planes that facilitate muscle surgery, leading to better long-term outcomes and faster functional recovery.…”

“…This simultaneous multispecialty approach may emerge as a novel treatment paradigm for similar cases involving the extraocular muscles. 9…”