Background: Meningeal carcinomatosis (MC) is a rare complication associated with hematologic and solid tumors.\r\nMC develops when malignant cells gain access to the leptomeningeal space, producing several clinical symptoms.\r\nLoss of vision and ocular motility deficit are the most frequent ocular symptoms reported. Fundus examination\r\nusually appears normal, although optic nerve alterations like optic atrophy or papilledema have been described. MC\r\ndiagnosis is usually completed by magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis.\r\nIndicated treatment for MC usually involves intrathecal chemotherapy combined with radiotherapy, although\r\nsurvival rate is extremely low.\r\nCase presentation: A 66-year old man with stage IV metastatic lung adenocarcinoma, presented to the\r\nOphthalmology Department with a two-month history of double vision, soft headaches and dizziness episodes. The\r\npatient presented a best visual corrected acuity of 0.7 in his right eye and 0.8 in his left eye. Diplopia was corrected\r\nwith 6-prism diopters base-out prism in right eye. Funduscopy showed a bilateral papilledema, juxtapapillary\r\nexudates and splinter hemorrhages. Brain MRI showed a diffuse leptomeningeal enhancement in cortical sulcus.\r\nLumbar puncture was performed and cerebrospinal fluid (CSF) cytology revealed malignant cells compatible with a\r\ndiagnosis of MC. Intrathecal chemotherapy was administered.\r\nConclusion: MC is a serious complication of systemic cancer patients, involving a poor prognosis. Early diagnosis is\r\nextremely important, although treatment is frequently aimed to reduce the symptoms and extend survival. Eye\r\nsymptoms may be the chief complaint, so MC should be considered in any patient with vision loss or diplopia\r\naccompanied by neurologic symptoms and in the absence of an intraocular cause, especially in the context of\r\nsystemic cancer.
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