From Breast to Sclera: A Silent and Devastating Invasion

Aim: This case report highlights about a silent and devastating invasion of Scleral metastases. Introduction: Ocular metastases remain a rare manifestation of systemic malignancies. Scleral involvement is an exceptionally uncommon presentation, often mimicking inflammatory conditions, which may delay diagnosis and management. Case Presentation: We present the case of a 48-year-old woman with a history of left breast invasive ductal carcinoma diagnosed three years earlier. She underwent conservative treatment, lymph node dissection, chemotherapy, radiotherapy, and was maintained on Tamoxifen. She consulted the emergency department for a painful red left eye evolving over three days. Ophthalmologic examination revealed an 8/10 best-corrected visual acuity, a firm scleral nodule with vascular disorganization, and dilated scleral vessels. Systemic workup showed multiple cutaneous nodules, left pleural effusion, and axillary lymphadenopathy. Histopathological examination confirmed metastatic involvement of the sclera from breast carcinoma. Despite corticosteroid therapy, the lesion progressed. Imaging revealed multiple pulmonary metastases and an intra-auricular thrombus, leading to comprehensive oncologic management. Discussion: Scleral metastases are extremely rare and often masquerade as nodular scleritis. The presence of a treatment-resistant scleral nodule in a neoplastic context should raise suspicion of secondary malignancy. A biopsy is crucial to confirm the diagnosis and initiate timely oncologic care. Conclusion: Although uncommon, scleral metastasis should always be considered in patients with a history of malignancy presenting with atypical ocular symptoms. Early recognition can improve overall prognosis and quality of life.