Breast cancer metastases to the paranasal sinuses are an infrequent occurrence, and diagnosis is often delayed due to misdiagnosis of headache or sinusitis. We present a case of a 49-year-old female with a history of breast cancer status post bilateral mastectomy whose metastatic breast cancer to the paranasal sinuses first manifested as orbital apex syndrome. In the clinical picture of sinusitis with orbital complications, awareness for metastatic disease in patients with a history of cancer should be maintained in the appropriate clinical setting. Physicians should be mindful of the possibility of this diagnosis as these patients are often initially evaluated for non-specific symptoms such as headache and congestion. This is an unprecedented case of metastatic breast cancer first presenting as orbital apex syndrome.
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