From Vision Changes to Hospice: The Rapid Progression of Orbital Metastasis in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is an aggressive primary liver malignancy with a high potential for metastasis, commonly involving the lungs, bones, and lymph nodes. However, orbital metastasis is an exceptionally rare presentation. This case describes a 73-year-old man with a history of HCC, hypertension, type 2 diabetes with neuropathy, chronic obstructive pulmonary disease (COPD), hepatitis C, liver cirrhosis, and portal hypertension who presented with a two-week history of blurry vision in the left eye, numbness on the left forehead, and a sensation of orbital fullness. He also reported an episode of unintentional bilateral upper extremity jerking followed by nausea and vomiting. Examination revealed left-sided proptosis, and imaging identified a retrobulbar orbital mass with muscle involvement. Biopsy confirmed metastatic HCC. Despite an initial referral for Y-90 radiotherapy, the patient was unable to undergo treatment due to multiple hospitalizations for unrelated conditions. Following the diagnosis of orbital metastasis, he experienced rapid functional decline, including multiple falls, cognitive deterioration, and loss of independence in activities of daily living, ultimately requiring hospice care. This case underscores the importance of recognizing rare metastatic patterns in HCC, especially in patients presenting with ocular symptoms. It highlights the severe consequences of delayed cancer treatment and the critical role of coordinated care in managing complex patients. Clinicians must remain vigilant in identifying unusual symptoms in patients with HCC to facilitate early diagnosis and timely intervention for advanced metastatic disease.