Inflammatory Presentation of Orbital Metastasis Years after Bilateral Mastectomy for Breast Cancer: A Case Report and Literature Review.

Introduction: Orbital metastasis is an uncommon but clinically significant manifestation of breast carcinoma and typically presents as a discrete orbital mass. Inflammatory orbital metastasis without a mass is exceptionally uncommon and can be misdiagnosed due to overlap with other orbital inflammatory conditions. This case highlights an exclusively inflammatory orbital metastasis 2 years after bilateral breast cancer treatment, underscoring the need for careful evaluation of orbital inflammation in patients with a cancer history. Case Presentation: A 51-year-old African-American woman with a history of bilateral ductal breast carcinomas treated with bilateral mastectomy and adjuvant therapy 2 years prior, presented with progressive right upper and lower eyelid swelling. Examination revealed bilateral symmetric anatomic exophthalmos, right-sided chemosis, and right soft periorbital edema. Neuroimaging demonstrated orbital fat stranding and lateral rectus enlargement without a discrete mass. Laboratory findings were largely unremarkable. She received high-dose corticosteroids with partial response and symptoms recurred upon tapering. Orbital biopsy of the lateral rectus and adjacent fat confirmed metastatic breast carcinoma. Systemic therapy with ribociclib and fulvestrant, coupled with orbital radiotherapy, led to marked clinical and radiographic response. Conclusion: A review of published literature highlights the rarity of inflammatory presentations of orbital metastases from breast carcinoma, particularly in the absence of a mass, which can lead to delayed diagnosis due to overlapping symptoms with other orbital pathologies. This case illustrates the importance of maintaining a high index of suspicion for metastatic disease in patients with a history of breast cancer presenting with orbital inflammation, even years after remission. Early biopsy in atypical or steroid-refractory cases is critical to ensuring timely diagnosis and management.