Invasive ductal breast carcinoma with orbital or/and ocular metastasis: rare case series and systematic review

Breast cancer is the most common malignancy among women worldwide with metastatic disease related to most recorded deaths. Although ocular and orbital metastases are rare, they are of high importance as they often present with nonspecific symptoms that may delay diagnosis leading to poor outcomes. We report three cases of invasive ductal breast carcinoma complicated by orbital metastases, highlighting clinical presentations, diagnostic steps, treatment and outcomes. All three patients developed orbital metastases in advanced stages of metastatic breast cancer, presenting with visual disturbances, diplopia, headache, and proptosis. One case was initially misdiagnosed as inflammatory orbital disease, resulting in delayed management. Magnetic resonance imaging was the best modality for diagnosis with biopsy unavailability. Palliative radiotherapy and systemic therapy led to relative symptomatic and radiologic improvement. A systematic literature review was also conducted, to identify reported cases of both orbital and ocular metastasis from invasive ductal carcinoma published between 1983 and 2025. Patient’s demographics, clinical presentation, diagnostic methods, treatment modalities, and outcomes were extracted and illustrated. The literature review identified 61 cases from 52 studies, with choroidal metastasis being the most common site. Visual impairment was the predominant presenting symptom. Despite visual improvement in many cases, overall prognosis remained poor. Ocular and orbital metastases from invasive ductal breast carcinoma are rare but may occur at any stage of disease. Early recognition and multidisciplinary management are essential to improve visual outcomes and quality of life. Rare but serious complication Ocular and orbital metastases from invasive ductal breast cancer are uncommon, yet they signal advanced systemic disease and are associated with poor prognosis. Nonspecific visual symptoms Patients often present subtle or vague visual complaints such as blurred vision, diplopia, or headaches that can delay diagnosis and complicate timely management. Choroid is the most vulnerable site Among ocular structures, choroid is most frequently affected, likely due to its rich blood supply that facilitates tumor cell seeding. Importance of multimodal diagnosis Early detection relies on careful ophthalmologic evaluation combined with MRI, CT, fundus examination, and sometimes biopsy, as single imaging techniques may miss small or early lesions. Multidisciplinary management improves quality of life While overall prognosis remains poor, combining systemic therapy, local interventions, and palliative care can relieve symptoms, preserve vision, and enhance patient quality of life.