Rare presentation of orbital metastasis in multiple myeloma

Orbital manifestations are rarely observed in multiple myeloma (MM) and when they occur, they are often the first manifestation. We report a rare occurrence of vision loss in a 51-year-old female from orbital metastases in MM without proptosis or diplopia. The ophthalmic presentation of MM is usually progressive proptosis, pain, diplopia, and visual loss. The presence of metastasis in MM indicates poor prognosis and orbital metastases have worse survival rates. In conclusion, in cases of profound vision loss with no obvious cause, neuroimaging should be performed to evaluate the orbital extent of the disease and exclude intracranial pathology.