Decreased Vision as an Early Sign of Nasopharyngeal Carcinoma

Rien Widyasari

Purpose
To report a case of nasopharyngeal carcinoma with decreased vision as an early sign.

Methods
Case report of a 58-year old man presented with slowly progressing blurred vision on the left eye since three weeks before admission. Visual acuity of the right eye was 6/5 with correction, and the left eye was 3/60 and uncorrectable. Ocular motility was good. Funduscopy results of both eyes were similar, round disc with distict edge, cup-disc-ratio (CDR) 0.3-0.4, aa/vv 1/3, crossing phenomenon (+), decreased macular reflex, cotton wool spots (+) and drusens (+).The Optical Coherence Tomography examination was within normal limit. Fundus fluorescence angiography examination showed hypofluorescein disc of the left eye. The Optical Coherence Tomography examination was within normal limit.The brain CT scan demonstrated a retrobulbar heterogenous mass infiltrating the medial and inferior rectus muscles of the left eye and a destruction of the left sphenoid bone with mass infiltration to the left parasella.

Results
Tissue biopsy of the mass were consistent to an undifferentiated type, non-keratinizing nasopharyngeal carcinoma (WHO 3), type A, middle stage carcinoma (Hsu's WF). This results was confirmed by ENT department.

Conclusion
The slowly progressing lost of vision could be an early sign of nasopharyngeal carcinoma. If the ophthalmologic findings are within normal limit, further examination will be required, such as MRI or CT scan.