Abstract
Purpose: To describe a case of biopsy-confirmed bilateral orbital metastasis of previously undiagnosed hepatocellular carcinoma, presenting with bilateral proptosis.
 Case description: A 57-year-old man presented with painless bilateral proptosis over 2 months. At presentation, the best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Ocular examination revealed bilateral asymmetrical non-axial proptosis with Hertel exophthalmometer reading of 24 mm in the right eye and 22 mm in the left eye. There was mild inferior displacement in both eyes. Apart from mild exposure keratopathy in the right eye, both anterior and posterior segment examinations were not remarkable. Orbital computerized tomography (CT) scan showed soft tissue masses in the superotemporal quadrants of both orbits associated with lytic bone lesions. An orbital biopsy confirmed that it was metastatic hepatocellular carcinoma (HCC). Ultrasound abdomen revealed multifocal HCC with underlying cirrhosis. We planned for further investigations such as hepatitis serology, alfa-fetoprotein, and CT abdomen, but he refused to proceed with investigations and treatment.
 Conclusion: Orbital metastasis, more so as a bilateral involvement, is a rare phenomenon. It may present as an initial manifestation of undiagnosed systemic cancer. Orbital metastasis should be considered when diagnosing patients with bilateral proptosis, and orbital biopsy is crucial for histopathological diagnosis.
Highlights
The orbit is an unusual site for cancer metastasis
Other risk factors include obesity, diabetes mellitus, cirrhosis related to heavy alcohol intake, non-alcoholic fatty liver disease, smoking, and ingestion of aflatoxin.[2,3]
We report a case of biopsy-confirmed orbital metastasis of Hepatocellular carcinoma (HCC) in a 57-year-old man, who first presented with painless bilateral proptosis
Summary
The orbit is an unusual site for cancer metastasis. Metastatic orbital tumors are rare conditions that account for 3–7% of all orbital neoplasms. Hepatocellular carcinoma (HCC) is a primary malignant tumor derived from hepatocytes It accounts for 80% of all liver cancers. We report a case of biopsy-confirmed orbital metastasis of HCC in a 57-year-old man, who first presented with painless bilateral proptosis. A 57-year-old man presented with blurred vision in the right eye for 15 days and bilateral, asymmetrical, painless, progressive proptosis of 2 months duration (Fig. 1). It involved the right eye first and eventually the left eye, but was more severe on the right.
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