AIM: To establish a meaningful standard for diagnosing ocular metastasis (OM) in menopausal breast cancer (BC) women, and explore the relationship between CA-153, CA-125, apolipoprotein A, and OM. METHODS: A total of 1362 menopausal female BC patients with OM volunteered to take part in this study between July 2012 and July 2022. Women with BC who are menopausal were found to have an OM incidence of 1.6%. Furthermore, CA-153, CA-125, and apolipoprotein A (Apo A) all contributed to OM in women with BC who are postmenopausal according to binary logistic regression. Receiver operating curve (ROC) analysis was used to assess the diagnostic value of OM in patients with BC. RESULTS: Both CA-153 and CA-153+CA-125 showed a higher sensitivity of 95.45%, whereas CA-153+Apo A illustrated the highest specificity of 99.02%. Moreover, CA-153 and CA-153+CA-125 had higher areas under the curve (AUC) of 0.973. CONCLUSION: The data indicate that the serum concentrations of CA-153 exhibited the most significant predictors of the diagnosis of OM in menopausal women with BC. The current study researches the utility of risk factors in predicting of OM in menopausal BC women and put forward the latest suggestions on their clinical application.