What happened, in summary

A 46-year-old man was diagnosed with Stage IV small cell lung cancer after pain, shortness of breath, weight loss and imaging showing a right lung lesion with bone involvement. He began palliative cisplatin and etoposide and completed 6 cycles, but frailty limited further use of that regimen. He then received second-line topotecan. During treatment, he developed increasing eye pain, proptosis and major vision loss. Orbital imaging showed bilateral infiltration of the extraocular muscles, including compression of the left optic nerve, consistent with rare orbital spread of his metastatic cancer. A lateral canthotomy was performed to relieve pressure on the left orbit, with only limited improvement in vision, and intensive eye care was needed for exposure-related damage. He remained on palliative chemotherapy as the systemic cancer progressed. He died 5 months after the orbital presentation.