Background: Meningeal carcinomatosis (MC) is a rare and serious complication associated with advanced hematologic and solid tumors. It can present with various ocular manifestations, and diagnosis is typically confirmed through magnetic resonance imaging and cerebrospinal fluid (CSF) analysis. Treatment often involves a combination of surgery, chemotherapy, and/or radiation; however, the disease is incurable, with a very low survival rate.
Case presentation: A 46-year-old woman presented to the ophthalmology department with complaints of vision loss. Funduscopy revealed a severely swollen optic disc (Frisen grade 5) with no visible optic disc margin and splinter hemorrhages. A contrast-enhanced chest computed tomography scan showed pulmonary nodules in the apex of the left lung. Analysis of CSF obtained through lumbar puncture confirmed the presence of malignant cells compatible with a diagnosis of MC.
Conclusion: MC is a severe complication of systemic cancer with a poor prognosis. Given that ocular symptoms can occasionally be the initial presentation, MC should be considered in patients experiencing vision loss or diplopia, even in the absence of an intraocular cause, neurologic symptoms, or a known history of systemic cancer. Comprehensive systemic examinations of major organs are crucial for early detection, diagnosis, and management of MC.
