a 61-year - old man presented with a rapidly expanding left periorbital mass which he had first noticed one month prior to presentation ( fig . the mass was firm with a pus - like discharge draining spontaneously from its center . his vision was 6/12 in both eyes ; the intraocular pressures were 22 mmhg in the right eye and 30 mmhg in the left eye an orbital ct scan revealed a well - defined 4.2 cm3.5 cm lesion in the left orbital and periorbital areas . we referred the patient to the department of hemato - oncology , where a systemic workup revealed a primary esophageal carcinoma , a tracheoesophageal fistula , a lung metastasis , and a right adrenal gland metastasis ( fig . in contrast to intraocular metastases , orbital metastases are a rare manifestation of systemic malignancies ; such orbital metastases account for only 1 - 13% of all orbital tumors . the incidence of orbital metastases has increased in recent years because improvements in treatment modalities and diagnostic tools have resulted in improved survival in cancer patients . occult cases have been reported : autopsy reports have revealed that 10 - 30% of breast cancer patients develop detectable ocular and orbital metastases . most orbital metastases arise from carcinomas , with lung , breast , and prostate being the most common primary sites . our literature search revealed only four reported cases of orbital metastases originating from esophageal tumors . orbital metastases usually occur during the advanced stage of cancer , although there is no known history of cancer in 19 - 25% of patients . ophthalmologic symptoms may be preceded by systemic symptoms , especially if the primary site is the lung , gastrointestinal tract , thyroid , or kidney . the most common manifestations of orbital metastases are diplopia , exophthalmos , inflammation , decreased visual acuity , pain , chemosis , and eyelid swelling , depending on the site affected . the symptoms usually occur acutely and progress rapidly , over the course of weeks to months . regardless of the primary tumor type , prognosis is poor , because patients with orbital metastases are usually at an advanced stage of the disease . in one report , the mean survival time was 7.4 months . in another report , the median survival time was 1.3 years , and the two - year survival rate is 27% . the survival duration was not significantly different among patients with different types of primary neoplasms . in our patient , the rapid growth of the metastatic cancer led to tumor necrosis and the clinical appearance of a periorbital abscess . prompt surgical biopsy enabled confirmation of a squamous cell carcinoma , and subsequent systemic evaluation revealed primary esophageal squamous cell carcinoma with multiple metastases . orbital and periorbital metastases can present atypically , and clinicians should be cognizant of this fact so that patients can be diagnosed in a timely manner .
a 61-year - old man with no history of malignancy presented with a rapidly expanding left periorbital mass , first noticed one month prior to presentation . 
 the mass was firm , and a pus - like discharge drained spontaneously from the center of the lesion . 
 a biopsy was performed , and histopathology confirmed squamous cell carcinoma . 
 systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases . 
 the prognosis of orbital metastasis is generally poor , and this patient expired after one month of conservative treatment .