Presentation of Orbital Metastases.

PURPOSE: The objective was to compare clinical characteristics of patients with and without a known systemic malignancy at the time of diagnosis of orbital metastases.

METHODS

Retrospective case note and imaging review for patients with orbital metastases presenting between 1980 and 2022. Patients were classified as having known malignancy at orbital presentation (group I) or without known malignancy (group II).

RESULTS

Of 159 patients with orbital metastases, breast cancer was the commonest (77/159; 48%), followed by neuroendocrine tumors (10%), melanoma (7%), and lung or prostate cancers (5% of each); cancers with unknown primary site comprised 11%. There were 105/159 (66%) group I patients with known primary tumor, their having more females (79% group I vs. 61% group II; p = 0.02), breast cancers (58% vs.30%; p = 0.0004), and melanomas (10% vs. 0%; p = 0.02). Compared with group II, group I had a lower rate of globe dystopia (21% vs. 38%; p = 0.03) and fewer extraconal lesions (33% vs . 50%; p = 0.05), but more involvement of the posterior third of the orbit (21% vs. 6%; p = 0.03). Imaging revealed a distinct orbital mass in 74%, with breast cancer often presenting as ill-defined or infiltrative lesions (29%).

CONCLUSION

Most orbital metastases originate from breast, neuroendocrine tumors, or melanoma, with about a third presenting before a primary systemic malignancy is detected. Those from breast and melanoma were more frequent in patients with a known primary tumor. Symptoms and signs were similar in patients with or without known systemic tumor at the time of orbital presentation, and most presented with features due to a mass effect.