Lagophthalmos and frozen globe as the initial presentation of invasive breast carcinoma

A 75-year-old woman presented with six months history of progressing lagophthalmos and immobility of the left eye. Magnetic resonance imaging (MRI) of the orbit demonstrated infiltration of orbital fat and the extra-ocular muscles. We performed transverse blepharotomy of the left eyelid to correct lagophthalmos; and during surgery, we took a biopsy sample from levator muscle and orbital fat. After the operation, the patient was able to close her eyelids, and epithelial problems were resolved. Biopsy revealed fibro-vascular, muscle and fat tissue infiltrated with minimally differentiated carcinoma cells. Breast examination revealed a nodule in the left breast. Biopsy of the mass confirmed the diagnosis of invasive breast carcinoma. Orbital manifestation of metastases, such as diplopia, lagophthalmos or pain may reduce life quality of the patients and must be evaluated on a multidisciplinary basis.