Unexpected finding: choroidal metastases

Ocular symptoms in cancer patients are a real diagnostic challenge nowdays for two reasons: the first one because the new drugs used in Oncology have a high rate of ocular toxicity, and the second one because a choroidal metastases is a very uncommon event…

CLINICAL CASE: A 54-year-old man with a diagnosis of disseminated esophageal carcinoma came to the clinic because a week before he started with some visual impairment, mainly when he was looking up. He has no ocular pain, no itching, but he referred the same disturbances in both eyes.

An ocular sonogram with Doppler model showed a bilateral choroidal metastases.

COMMENTS: cancer cells reach the choroidal area via the arterial ophtalmic and cilliary system. The most common histology is carcinoma coming from the lung, breast, gastrointestinal area, kidney and others. Metastatic melanoma is also a common origin.

The diagnosis of choroidal metastases can be missed because almost 50% of them are asymptomatic. More common symptoms are: vision loss, scotoma, photopsies, ocular pain, diplopia or red eye.

Here we show a sonogram-Doppler from this patient with a bilateral choroidal metastases.