Metastatic breast cancer presenting as an epithelial defect

A 62-year-old woman was referred for evaluation of a nonhealing epithelial defect of the left eye. Examination also revealed left upper lid ptosis, cicatricial lagophthalmos, and palpable lid masses. With probing, the patient admitted to recent history of lobular carcinoma and remote history of ductal carcinoma of the breast. Imaging showed abnormal tissue in the left extraconal orbit involving the lacrimal gland. After orbitotomy and biopsy of the mass, pathology specimens returned consistent with metastatic carcinoma of the left orbit with breast as the site of the primary tumor. The patient completed palliative radiation therapy and chemotherapy. Amniotic membranes were placed to promote healing of the persistent epithelial defect with good response. Unfortunately, the patient died approximately 1 year after her initial presentation secondary to her oligometastatic disease. There is a wide spectrum of clinical manifestations associated with orbital metastasis. Careful consideration must be given to cancer patients with ophthalmologic complaints.