Atypical orbital metastasis from invasive lobular breast carcinoma masquerading as a hordeolum

Metastatic spread of invasive lobular carcinoma (ILC) to the eyelid is exceedingly rare and may masquerade as benign disease. We describe a woman in her 60s with a history of multifocal, estrogen receptor-positive ILC who presented with progressive, painless right periorbital swelling mimicking cellulitis. She was initially managed for presumed hordeolum and preseptal cellulitis without response over 4 months. 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.