Introduction: To report an unusual presentation of metastatic prostate cancer to the orbit in an immunosuppressed patient, who received a novel palliative treatment regimen.

Materials And Methods: A 56 year old HIV+ man presented with proptosis and unilateral blindness. The diagnosis, work up, and treatment are outlined.

Results: Metastatic prostate cancer to the orbit is diagnosed, and the treatment with IMRT and hormone ablation is explored.

Conclusion: We outline the literature and current thinking surrounding prostate cancer metastases to the orbit. HIV+ patients currently enjoy longer life expectancies, with the caveat that their immunosuppressed status may lead to more unusual metastatic presentations. Treatments and palliation will continue to evolve as these new cases emerge.

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