Ocular metastases

Abstract

The eye is a rare site for disseminated malignancy because of the absence of a lymphatic system. Metastases to the ocular structures occur by haematogenous spread and therefore the parts of the eye with the best vascular supply are most likely to be affected. Many patients with Stage 4 carcinomatosis (distal metastatic spread) already have a history of a previous primary cancer. However, this is not always the case for lung cancer as this can metastasise early to the uveal tract and therefore the ophthalmologist may be the first to discover the presence of terminal metastatic disease. Broadly speaking, treatment options are focused on improving the patients' quality of life if visual acuity is threatened. Long-term side effects of treatment need to be considered as systemic cancer treatments and therefore patient life expectancy is improving. In this manuscript, presented at the Cambridge symposium 2012, the diagnosis and challenges involved in the management of ocular metastases are presented.

Figure 1

(a) Iris metastases seen in a patient undergoing treatment for a chronic episcleritis. The lady had a history of ductal adenocarcinoma of the breast; investigations revealed disseminated metastases with intracranial involvement. (b) Leopard spot retinal pigment epithelial change seen over the surface of a posterior polar choroidal metastases. A primary carcinoma was subsequently discovered in the wall of the oesphagus. (c) Subtotal exudative retinal detachment associated with a solitary choroidal metastasis. The patient had no previous history of malignancy but investigations revealed metastatic non-small-cell carcinoma of the lung. (d) Pars plana fine needle aspiration biopsy. Passage of the needle through the vitreous gel reduces the risk of extra-ocular seeding. (e) Isolated choroidal metastasis from undiagnosed primary ductal carcinoma in a man. The tumour was oestrogen receptor positive and responded to systemic tamoxifen. (f) Two years later, the breast metastasis regressed to a flat area of choroidal atrophy.