Redness and periocular pain in a patient with metastatic renal cell carcinoma
Akella, Madhuri; Singh, Simar R; Dogra, MohitRead More
A 33-year-old male, on treatment for metastatic renal cell carcinoma, presented with redness, heaviness and dull pain in his right eye over the past 10 days. He had undergone a left nephrectomy and received multiple cycles of cisplatin-based chemotherapy one year ago for clear-cell type renal cell carcinoma. He was currently in remission and was being maintained on fortnightly intravenous nivolumab injections since the past 6 months. Best-corrected visual acuity was 20/50 and 20/20 in the right and left eye respectively and the right eye had a relative afferent pupillary defect and defective color vision (on Ishihara chart). Anterior segment evaluation of the right eye showed conjunctival congestion while the fundus revealed an elevated optic disc with blurred margins. Extraocular movements and intraocular pressures were within normal limits. Left eye examination was unremarkable. Magnetic resonance imaging of the orbit showed hyperintensity and increased thickness of the preseptal orbital tissue [Fig. 1, red arrow] and thickening of the optic nerve (blue arrow) in the right eye.