Sudden vision loss as a presenting feature of optic nerve compression in a patient with breast cancer: a case report

48 year old female patient presented with complaints of loss of vision, pain and drooping of right upper lid for 25 days. On right eye examination patient had perception of rays in four quadrants, severe ptosis with mild restriction in extra-ocular movements inferiorly and medially and relative afferent pupillary defect. Dilated fundus examination was normal. Left eye examination was normal with best corrected visual acuity 6/6. MRI revealed myositis/ edema with bulky inferior rectus and medial rectus muscles with ill-defined enhancing lesions in soft tissue in right orbit suggestive of inflammatory/thyroid orbitopathy. To start injection Methylprednisolone, Chest X Ray was done which revealed sclerotic metastases. Ultrasonomammography revealed mass in right retro areolar region with right axillary lymphadenopathy. Ultrasound Abdomen with Pelvis showed liver metastases.  X ray skull and pelvis with hip joints was suggestive of metastases. True cut biopsy of the breast lump revealed Lobular carcinoma (T4b N1 M1). Keywords: First presentation, Metastatic Breast Cancer, Optic nerve compression, Orbital metastasis, Vision Loss