BACKGROUND: Choroidal malignancies can be primary or metastatic. Breast, lung or unknown primary tumors are most common yet ocular findings may be the first detected sign of a metastatic condition. Presenting symptoms can be blurred vision, flashes, floaters, visual field defects or most often none at all. Rapid referral for primary site and other metastatic detection and treatment is recommended along with management of the ocular condition.
CASE REPORT(S): A 38-year-old white female presented with concern of a constant kaleidoscope effect inferior temporal to primary gaze OS 3 weeks in duration. History was positive for hypothyroid and classic migraine but no headache was associated with this atypical and localized visual disturbance. Distance acuities were 20/15 OD/OS. Anterior segment was normal. Dilated exam OS revealed an elevated 1.67DD lesion just superior to the nerve and a single retinal hemorrhage 0.5DD temporal to the nerve. OCT line scan showed a serous detachment surrounding the lesion. 30-2 HVF demonstrated a corresponding dense inferior temporal defect. Exophthalmometry was normal/equal. Further questioning revealed a grandmother deceased from a blinding brain tumor.
She was referred for B-Scan and FA. A metastatic work-up was initiated through Primary Care. Chest x-ray showed a 10x13mm lesion right mid-lung. Colonoscopy was normal but biopsy revealed invasive moderately differentiated adenocarcinoma. CT and PET scan showed extensive metastatic disease involving the mediastinum, lung, liver, pancreas, subcutaneous, bone, orbit and brain with gastrointestinal or pancreas as primary site. She was referred to a cancer center where she underwent chemotherapy and whole brain radiation. She expired 10 months later.
CONCLUSIONS: Gastrointestinal cancers metastasize to the eye in about 2% of women. This case demonstrates a unique presentation of initial ocular detection of extensive metastatic disease in a young patient reporting good health. Extensive test results will be presented along with differential diagnoses, pathophysiology and treatments both available and proposed.