Ewha Med J.  2017 Jul;40(3):136-139. 10.12771/emj.2017.40.3.136.

Unilateral Ptosis with Bilateral Incomplete Ophthalmoplegia as the Initial Presentation in Metastatic Cancer

  • 1Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea. pkd1165@ewha.ac.kr
  • 2Department of Ophthalmology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.


Orbital metastases are rare and predominantly unilateral occurrences. Bilateral metastases affecting the extraocular muscles are extremely rare. A few case reports of bilateral metastases to extraocular muscles described binocular diplopia with conspicuous bilateral external ophthalmoplegia as an initial symptom. We report a case in which unilateral ptosis was an initial symptom and bilateral incomplete ophthalmoplegia was found on initial neurologic examination in invasive ductal carcinoma of the breast. The patient had hormone receptor-positive breast cancer, and so was treated by hormonal therapies and closely monitored. The presence of a secondary orbital lesion presents many difficulties of differential diagnosis and treatment. A thorough neurologic examination to detect ocular manifestations is most important for localization and broad differential diagnosis including mechanical orbital metastatic lesion.


Orbital neoplasms; Neoplasm metastasis; Neurologic examination; Carcinoma, ductal, breast

MeSH Terms

Breast Neoplasms
Carcinoma, Ductal
Carcinoma, Ductal, Breast
Diagnosis, Differential
Neoplasm Metastasis
Neurologic Examination
Orbital Neoplasms


  • Fig. 1 Extraocular muscles examination (A) and orbit magnetic resonance imaging (MRI) findings (B). Extraocular movement examination reveals slightly limited abduction and adduction in the right eye, and slightly limited elevation and abduction in the left eye. Left eye ptosis is evident with margin reflex distance 1 of 3 mm. Axial and coronal section of the orbit MRI shows enhancing mass (0.9×1.2×2.1 cm) in the right lateral rectus muscle of the right eye. There are enhancing masses in left medial rectus muscle of the left eye and intraconal lesion around left medial rectus muscle. Coronal section of the orbit MRI shows enhancing mass (6.7×2.5×1.5 cm sized) in left superior lateral extraconal area, which suggests the high probability of metastasis.


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