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She was initially managed for presumed hordeolum and preseptal cellulitis without response over 4\u2009months. Orbital MRI demonstrated non-specific preseptal thickening without a discrete mass. Given persistent symptoms, biopsy was pursued and revealed poorly differentiated carcinoma with immunohistochemical features consistent with breast origin. A repeat biopsy confirmed metastatic ILC with histiocytoid and signet ring cell morphology. This case highlights that orbital or eyelid metastasis from ILC can closely mimic inflammatory conditions and imaging may be non-diagnostic, delaying diagnosis. Clinicians should maintain suspicion for metastatic disease in patients with a history of breast cancer who develop unexplained orbital or eyelid changes to enable timely recognition and management.<\/jats:p>","DOI":"10.1136\/bcr-2025-270174","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:10:11Z","timestamp":1785845411000},"page":"e270174","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Atypical orbital metastasis from invasive lobular breast carcinoma masquerading as a hordeolum"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2725-0133","authenticated-orcid":false,"given":"Anusha","family":"Mamidipaka","sequence":"first","affiliation":[{"name":"Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar","family":"Brice\u00f1o","sequence":"additional","affiliation":[{"name":"Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Lee","sequence":"additional","affiliation":[{"name":"Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080405100508000_19.8.e270174.1","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.preteyeres.2018.09.003","article-title":"New concepts in the diagnosis and management of choroidal metastases","volume":"68","author":"Mathis","year":"2019","journal-title":"Prog Retin Eye Res"},{"key":"2026080405100508000_19.8.e270174.2","doi-asserted-by":"crossref","DOI":"10.3390\/cancers16081518","article-title":"Ocular and Periocular Metastasis in Breast Cancer: Clinical Characteristics, Prognostic Factors and Treatment Outcome","volume":"16","author":"Yousef","year":"2024","journal-title":"Cancers (Basel)"},{"key":"2026080405100508000_19.8.e270174.3","doi-asserted-by":"publisher","DOI":"10.1080\/01676830902897470"},{"key":"2026080405100508000_19.8.e270174.4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3233\/BD-190398","article-title":"Orbital metastases of invasive lobular breast carcinoma","volume":"38","author":"Tsagkaraki","year":"2019","journal-title":"Breast Dis"},{"key":"2026080405100508000_19.8.e270174.5","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(90)90045-W"},{"key":"2026080405100508000_19.8.e270174.6","doi-asserted-by":"publisher","DOI":"10.1097\/00002341-200201000-00014"},{"key":"2026080405100508000_19.8.e270174.7","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1097\/IOP.0b013e3182916537","article-title":"Orbital metastasis as the initial presentation in bilateral lobular invasive carcinoma of the breast","volume":"30","author":"Saffra","year":"2014","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"2026080405100508000_19.8.e270174.8","doi-asserted-by":"publisher","DOI":"10.1097\/00002341-200109000-00009"},{"key":"2026080405100508000_19.8.e270174.9","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11040725","article-title":"Unilateral Orbital Metastasis as the Unique Symptom in the Onset of Breast Cancer in a Postmenopausal Woman: Case Report and Review of the Literature","volume":"11","author":"Oprean","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2026080405100508000_19.8.e270174.10","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1080\/01676830.2017.1310255","article-title":"Orbital and conjunctival metastasis from lobular breast carcinoma","volume":"36","author":"S\u00e1nchez Orgaz","year":"2017","journal-title":"Orbit"},{"key":"2026080405100508000_19.8.e270174.11","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s13691-024-00697-z","article-title":"General characteristics of orbital metastasis in breast cancer: a narrative review of case reports","volume":"13","author":"Zarei","year":"2024","journal-title":"Int Cancer Conf J"},{"key":"2026080405100508000_19.8.e270174.12","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1038\/sj.eye.6700535","article-title":"Screening for ophthalmic involvement in asymptomatic patients with metastatic breast carcinoma","volume":"18","author":"Fenton","year":"2004","journal-title":"Eye (Lond)"},{"key":"2026080405100508000_19.8.e270174.13","doi-asserted-by":"publisher","DOI":"10.1097\/ICU.0b013e3282c5077c"},{"key":"2026080405100508000_19.8.e270174.14","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1971.00990050675005"},{"key":"2026080405100508000_19.8.e270174.15","doi-asserted-by":"crossref","unstructured":"Papudesu C , Burkat CN , Potter HAD . 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