Visual loss secondary to orbital apex invasion as the first manifestation of recurrent nasopharyngeal carcinoma

A 51-year-old white man was referred for evaluation of visual loss in the right eye caused by an apical orbital lesion. His medical history was positive for "lymphoepithelial carcinoma" of the nasopharynx successfully treated with radiotherapy 6 years previously. Cranial CT showed a diffuse orbital mass extending from the pterygopalatine fossa, infiltrating the inferior orbital fissure, the orbital apex, and the cranial cavity. Results from an incisional biopsy of the lesion were consistent with the diagnosis of nasopharyngeal carcinoma, nonkeratinizing lymphoepithelial variant of squamous cell carcinoma. The patient underwent stereotactic radiosurgery, which arrested the tumor progression. Orbitocranial recurrence of nasopharyngeal carcinoma is rare and ocular symptoms may be the first manifestation of the disease.