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Sino-orbital metastasis as the initial presentation of advanced breast cancer
  1. Mohamad Kamil Muhammad-Ikmal1,
  2. Nurul Ain Masnon2,
  3. Firdaus Hayati3 and
  4. Wan-Hazabbah Wan HItam2
  1. 1Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  2. 2Department of Ophthalmology and Visual Sciences, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Kelantan, Malaysia
  3. 3Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  1. Correspondence to Dr Mohamad Kamil Muhammad-Ikmal; dr.ikmalkamil{at}


A woman in her 70s presented with reduced vision in her left eye, progressive narrowing of right eye opening for 6 months and anosmia. On examination, she had right enophthalmos and pseudoptosis with inferior globe dystopia. Her visual acuity was 6/9 and nil light perception in the right and left eyes, respectively. Extraocular muscle examination showed limited right up gaze. Funduscopy showed a normal right optic disc and left optic disc atrophy. Systemic examination revealed left breast ulceration with skin tethering. CT revealed an infiltrative mass invading the ethmoidal sinuses, frontal sinuses and both orbits. A histological diagnosis of infiltrative ductal breast carcinoma was made after nasal endoscopic and left breast biopsy. She underwent palliative chemoradiotherapy and survived with good disease control after 1 year. Metastatic carcinoma is a differential diagnosis of a sino-orbital mass, and comprehensive clinical assessment is indicated for all patients presenting with non-acute eye injury.

  • Breast cancer
  • Head and neck cancer
  • Chemotherapy
  • Radiotherapy
  • Visual pathway

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  • Contributors MKM-I and NAM contributed in design, data acquisition, data analysis, literature search, and manuscript preparation. FH contributed in literature research, manuscript editing and manuscript review. W-HWH contributed in manuscript editing and manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.