Galaxies reflected in a human eye representing orbital metastasis.

When Cancer Affects Your Vision: Understanding Orbital Metastases

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"A closer look at how neuroendocrine tumors can impact the eyes and what it means for treatment and surveillance."

Metastasis, the spread of cancer from its primary site to other parts of the body, can occur in various locations. One rare and often overlooked area is the orbit, the bony socket that houses the eye. Orbital metastases, while uncommon, can present significant challenges, particularly when they originate from midgut neuroendocrine tumors (NETs).

Neuroendocrine tumors are a diverse group of neoplasms arising from neuroendocrine cells, which are found throughout the body. Midgut NETs, specifically, originate in the small intestine and can sometimes spread to distant sites. When these tumors metastasize to the orbit, they can cause a range of visual disturbances and discomfort.

This article delves into the intricacies of orbital metastases from midgut NETs, drawing upon a two-institution experience to shed light on detection, symptoms, and evolving treatment approaches. Understanding this rare manifestation is crucial for both patients and healthcare professionals to ensure timely and effective management.

What Are Orbital Metastases and Why Are They Significant?

Galaxies reflected in a human eye representing orbital metastasis.

Orbital metastases refer to the spread of cancer cells to the bony socket surrounding the eye. This occurrence is relatively rare, accounting for only a small percentage of all cancer metastases. However, when it does happen, it can lead to a variety of symptoms that significantly impact a person's quality of life.

The significance of orbital metastases lies in several factors:

Visual Impairment: Orbital metastases can directly affect vision, causing double vision (diplopia), decreased vision, and even vision loss.
Physical Discomfort: Symptoms such as proptosis (bulging of the eye), eyelid swelling, and pain can cause considerable physical discomfort.
Diagnostic Challenges: Detecting orbital metastases can be challenging, as initial symptoms may be subtle or attributed to other causes.
Treatment Implications: The presence of orbital metastases can alter treatment strategies, requiring a multidisciplinary approach to manage both the primary tumor and the spread to the orbit.

Historically, diagnosing orbital metastases relied heavily on orbital MRI, which remains a gold standard for imaging orbital disease. However, advancements in systemic imaging modalities, particularly somatostatin-receptor (SSTR) based imaging such as 68Ga-DOTATATE PET-CT, have improved detection rates. These imaging techniques allow for earlier identification of orbital lesions, sometimes even before symptoms manifest.

The Future of Managing Orbital Metastases

The management of orbital metastases from midgut NETs is evolving. While local treatments like radiation therapy remain essential, the integration of systemic therapies, including PRRT, offers new hope for controlling both the primary tumor and its spread. Multidisciplinary care, involving ophthalmologists, oncologists, and radiation specialists, is crucial to optimize patient outcomes. Continued research and collaboration will further refine treatment strategies and improve the quality of life for those affected by this rare condition.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What are orbital metastases, and why should patients with midgut neuroendocrine tumors (NETs) be aware of them?

Orbital metastases refer to the spread of cancer cells specifically to the bony socket surrounding the eye, known as the orbit. While they are rare, they are significant for individuals with midgut neuroendocrine tumors (NETs) because these tumors can sometimes spread to distant sites, including the orbit. The presence of orbital metastases can lead to visual impairment like double vision or vision loss, physical discomfort such as eye bulging and pain, diagnostic challenges, and alterations in treatment strategies, emphasizing the need for awareness and timely management.

How are orbital metastases from midgut NETs typically detected, and what advancements have improved early diagnosis?

Historically, orbital metastases were primarily diagnosed using orbital MRI, which remains a gold standard. However, advancements in systemic imaging, particularly somatostatin-receptor (SSTR) based imaging such as 68Ga-DOTATATE PET-CT, have significantly improved detection rates. These techniques allow for earlier identification of orbital lesions, sometimes before symptoms even manifest. The improved detection enables earlier intervention and potentially more effective management of the condition.

What are the main symptoms associated with orbital metastases, and how can they impact a patient's quality of life?

The primary symptoms of orbital metastases include visual impairment, such as double vision (diplopia) and decreased vision, as well as physical discomfort like proptosis (bulging of the eye), eyelid swelling, and pain. These symptoms can significantly impact a person's quality of life by affecting their ability to perform daily tasks, causing discomfort, and potentially leading to emotional distress. Early recognition and management of these symptoms are crucial for improving patient well-being.

What treatment options are available for managing orbital metastases originating from midgut NETs, and why is a multidisciplinary approach important?

Management of orbital metastases from midgut NETs involves a combination of local and systemic treatments. Local treatments, such as radiation therapy, are often essential for addressing the orbital lesions directly. Systemic therapies, including peptide receptor radionuclide therapy (PRRT), can help control both the primary tumor and its spread. A multidisciplinary approach involving ophthalmologists, oncologists, and radiation specialists is crucial to optimize patient outcomes by ensuring comprehensive care that addresses all aspects of the disease.

Considering that orbital metastases from midgut NETs are rare, what ongoing research or future directions are aimed at improving treatment and outcomes for affected individuals?

Continued research and collaboration are essential to further refine treatment strategies and improve the quality of life for those affected by orbital metastases from midgut NETs. Specific areas of focus may include: (1) Developing more targeted therapies that can selectively attack cancer cells in the orbit while sparing healthy tissue; (2) Improving imaging techniques to detect orbital metastases at even earlier stages; (3) Exploring the use of novel systemic therapies that can effectively control the spread of midgut NETs to distant sites; (4) Conducting clinical trials to evaluate the efficacy of different treatment combinations and approaches.