Summary
Background Orbital metastatic disease usually leads to exophthalmos but rarely to enophthalmos.
We report a case of a metastasis causing enophthalmos.
Patient A 68-year-old woman had mastectomy for breast cancer six years prior to presentation.
She complained of double vision when looking sideways. The right eye showed a motility
reduction in all directions and a slight ptosis. She had 4 mm enophthalmos, and the
eyelids were sunk into the orbit. There were no signs of optic nerve damage. Magnetic
resonance imaging showed a retrobulbar mass surrounding the optic nerve and infiltrating
the muscles. The space of the orbital fat was reduced. A biopsy confirmed the diagnosis
of metastatic breast carcinoma. Histologically, the connective tissue was infiltrated
by lymphocytes, and the nuclei of the tumor cells where aligned in a linear “Indian
file” pattern. 30% of the tumor cells contained the estrogen-receptor protein, 40%
the progesteron-receptor protein. The CA-15/3 and CEA levels were elevated. The patient
underwent orbital radiation with 50 Gy. During the following 2 months, the enophthalmos
encreased to 6 mm.
Discussion We suggest the following hypothesis as the cause of enophthalmos in orbital metastases:
The tumor growth goes along with fibrosis. Subsequent shrinkage of the connective
tissue pulls the eye back into the orbit. The ensuing elevation of tissue pressure
leads to atrophy of the retrobulbar fat. The increase of tumor volume is too slow
to compensate for the fat atrophy.
Slowly progressive enophthalmos with reduced motility is nearly pathognomonic of metastatic
scirrhous breast carcinoma. In rare cases, a diffusely infiltrating carcinoma of the
gastrointestinal tract may cause a similar picture.
Schlüsselwörter
Enophthalmus - Orbita - Mamma-Carcinom - Metastase
Key words
Enophthalmos - orbit - breast cancer - metastasis
