A ‘never miss’ diagnosis: Ptosis secondary to metastatic breast cancer diagnosed as involutional ptosis and a review of the literature

Abstract

We present a case of ptosis secondary to metastatic lobular carcinoma of the breast which was initially diagnosed as involutional ptosis. A 67-year-old woman previously diagnosed with lobular carcinoma of the breast presented to our clinic with mild restriction of lateral gaze and persistent droopiness of her right eyelid (associated with decreased levator function) despite recent repair of a suspected involutional ptosis. Orbital magnetic resonance imaging revealed a mass in the right orbit which was biopsied and diagnosed as lobular carcinoma of the breast. Poor levator function is rarely present in involutional ptosis. Especially in conjunction with abnormal extraocular motility, other etiologies of acquired ptosis must be considered. This case highlights the importance of patient history and ocular examination in identifying the underlying etiology of ptosis. A review of the literature to evaluate the incidence of signs and symptoms associated with metastatic breast cancer to the orbit is included.

Unilateral acquired blepharoptosis due to orbital metastatic disease as an initial presentation of an overlooked breast carcinoma — A case report

“…A review of 116 eyes with orbital metastasis from breast cancer suggested that two thirds of the patients were at an age of more than 50 years at presentation and only 20 % had blepharoptosis. Invasive ductal carcinoma was noted in 27.8 % of metastatic lesions and was second to invasive lobular carcinoma [ 9 ]. This is a unique case of unilateral blepharoptosis of the mechanical type due to metastatic orbital disease originating from a primary ductal breast carcinoma causing restriction of the levator muscle due to the fibrotic nature of the lesion.…”