Orbital metastasis from breast carcinoma: structured literature review and report of four cases.

Purpose: Breast carcinoma is the most commonly diagnosed cancer worldwide and represents the most common primary tumor metastasizing to the orbit. Herein, we present the largest review of the clinical features of orbital metastases from breast carcinoma reported in the literature and describe four additional patients. Methods: Case reports and case series of biopsy-proven orbital metastases from breast carcinoma published between 2011 and 2025 were identified through a MEDLINE search. Of 220 records screened, 63 articles (29%) met inclusion criteria. Titles, abstracts, and full texts were reviewed for eligibility. Data extracted included patient demographics, tumor subtype and receptor status, timing of breast cancer diagnosis relative to orbital presentation, clinical features, imaging findings, treatments, and survival outcomes. Results: Sixty-nine cases of breast carcinoma metastatic to the orbit from 63 articles were reviewed. The majority of patients were female (66 of 69, 96%). The average age at presentation of orbital symptoms was 60 years. Orbital metastasis was the presenting manifestation of breast cancer in 30/69 patients (43%). In 15 of 69 patients (22%), orbital metastasis was initially diagnosed as a different orbital process. Among the 49 patients for whom primary tumor type was reported, 25 of 49 (51%) had lobular carcinoma and 21 of 49 (43%) had ductal carcinoma. Two patients had independent lobular and ductal primaries, and one patient had a phyllodes tumor. The most common presenting orbital signs or symptoms were diplopia and/or limited motility (45 of 69, 65%) and decreased or blurry vision (33 of 69, 48%). Treatment of the primary breast carcinoma with orbital metastases varied widely and changed over time with near-equal representation of chemotherapy, hormonal therapy, and radiation therapy. Documentation of survival time was inconsistent. Conclusions: Breast carcinoma, including metastatic disease, is increasingly characterized by improved survival and prolonged disease control in selected patients with advances in systemic therapy. In patients with a history of breast cancer, metastatic disease should be considered in those presenting with orbital pathology. Conversely, unexplained orbital findings may warrant evaluation for occult malignancy.