Ocular Flutter as The First Sign of a Breast Carcinoma

Article Abstract

Introduction: Ocular flutter is a rare ophthalmic finding and can be the presenting sign of potentially serious disease. The most common etiology is a paraneoplastic disorder and therefore, a workup for a malignancy should always be initiated.

Case Report: We present a case of a 48-year-old female who presented with a two-month history of progressive anorexia, wasting, vomiting and vertigo and recently associated complaints of diplopia and blurred vision. Ophthalmic examination revealed horizontal saccadic intrusions, consistent with ocular flutter. Further extensive workup revealed an adenocarcinoma of the right breast. Immunologic testing showed positive anti-Ri antibodies which are reported to be associated with breast carcinomas and a paraneoplastic syndrome. The patient underwent local excision and adjuvant chemotherapy, radiotherapy and hormonal therapy were administered. The clinical picture deteriorated rapidly to an overt opsoclonus and a gait disorder. Six months after the initial presentation, she became symptom free.

Conclusion: Ocular flutter is an alarming finding and should always alert the clinician to screen for a potential underlying malignancy.

Article Citation

Maes C, Janssens H, Goovaerts L, Dieltiens M, Schrooten M, Cassiman C. Ocular flutter as the first sign of a breast carcinoma. Video Journal of Clin Ophthalmol 2017;1:1–4.

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Author Speaks

“We report on a case of a 48-year old woman with ocular flutter as the presenting sign of a breast carcinoma. Ocular flutter is a rare ophthalmic finding but can be the presenting sign of a potentially serious disease. Together with opsoclonus it makes part of the spectrum of the saccadic intrusions with the same etiology, pathophysiology and clinical implications. The most common etiology in adults is a paraneoplastic syndrome.Tumours most frequently associated are lung and breast carcinoma. We present this case to demonstrate the importance of recognising ocular flutter and opsoclonus in clinical practice as soon as possible. Often patients present first with aspecific symptoms and time to diagnosis can be delayed. The diagnosis is based on recognising the clinical image as soon as possible and starting urgent further investigations to screen for potential malignancy. Further immunologic examinations can confirm the diagnosis but are mostly negative. In general paraneoplastic ocular flutter and opsoclonus have a severe course and most patients recover only partial. Primary tumour treatment is the mainstay of therapy. Further treatment options include immunosuppressive therapies and anticonvulsants.”

– Author Name: Maes Chlara

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