Orbital metastasis associated with primary breast carcinoma in a man detected during peribulbar anesthesia for cataract surgery

PURPOSE. A case of orbital infiltration by breast carcinoma in a male patient causing mild enophthalmos and subcutaneous mass detected accidentally during peribulbar anesthesia for cataract surgery is discussed. METHODS. The authors report a case of a 65-year-old man who came to the Ophthalmology Department for cataract surgery. During the presurgery peribulbar injection, a hard palpable mass located under the inferior left eyelid was noted, together with mild enophthalmos. A historical clinical screening revealed that 5 years previously the patient had undergone a right radical mastectomy to treat a ductal carcinoma of the breast. RESULTS. The patient underwent an incisional biopsy of the orbital mass that confirmed the clinical hypothesis of a metastasis. DISCUSSION. This case highlights the importance of the collection and screening of detailed clinical information on the patient before every ophthalmic operation including cataract surgery, The occurrence of progressive enophthalmos can represent an unusual symptom of orbital metastasis, commonly presenting with proptosis and diplopia