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Background: Isolated metastasis to the optic nerve (ON) and its sheath from breast cancer (BC) without involvement of other ocular structures is extremely rare. However, it is a pivotal diagnosis to rule out as it is a both sight- and life-threatening condition. We report a case of isolated ON sheath metastasis from BC presenting with central retinal vein occlusion (CRVO).
Case presentation: A 47-year-old woman with known metastatic BC presented with painless, progressive vision loss in the left eye. Visual acuity was hand movement with ipsilateral relative afferent pupillary defect. Fundal features suggested CRVO. Atypical rapid resolution of these features led to suspect ON metastasis. Magnetic resonance of the brain showed perineural enhancement of the optic nerves. Vision improved with radiotherapy.
Conclusion: Isolated ON sheath metastasis from BC is rare and may present with CRVO. High degree of suspicion is warranted in patients with metastatic disease and atypical findings.