Orbital metastasis

Case contribution: Dr Radhiana Hassan


  • A 49 years old lady
  • Known case of left breast cancer, mastectomy done 5 years ago
  • Completed radiotherapy and chemotherapy
  • Presented with right periorbital swelling and diplopia
  • No history of trauma, no fever.
  • No constitutional symptoms
CT scan of orbit in axial plane soft tissue window post contrast
CT scan brain coronal reformatted in soft tissue window post contrast
CT brain in axial plane soft tissue window post contrast
CT scan brain in axial plane bone window post contrast

CT scan findings:

  • Mildly enhancing soft tissue mass in the extraconal region of right orbital cavity (red arrows). It is located at lateral and inferior quadrant. No calcification seen.
  • The right lacrimal gland also looks bulky (blue arrows).
  • Extraocular muscles are normal in size and symmetrical in appearance.
  • Optic nerve is normal.
  • In the brain, there are a few enhancing lesions in the left temporal lobe and left occipital lobe (yellow arrows).
  • There is extensive lytic sclerotic lesions of the skull vault and facial bones.

Progress of patient:

  • Subsequent CT thorax shows multiple lung metastasis.
  • Also had multiple liver metastasis.

Diagnosis: Multiple metastasis from breast cancer.


  • Orbital metastases are infrequent; about 6% of all orbital mass biopsied are metastatic in origin.
  • Extraocular metastases accounts for 2-11% of all orbital neoplasms.
  • Breast carcinoma and lung carcinoma are the most common primary tumours of orbital metastasis.
  • Not infrequently, patients have silent brain lesion when they present with orbital disease. Thus, imaging of whole brain should be included.
  • Extraocular metastasis are usually unilateral and only infrequently primarily involve the extra-ocular muscles.
  • The superior and lateral extraconal quadrant is the most frequently involved although any parts can be involved.
Author: radhianahassan