Anterior Uveal Metastasis
Metastatic Breast Cancer
Written by Paul T. Finger, MD
Uveal metastasis is the most common malignant intraocular tumor and may occur in as many as 10% of patients with metastatic cancer.
Metastatic Lung Cancer
Metastatic breast cancer is the most common in women and lung is the most common in men.
Other primary sites include prostate, skin, kidney, colon and thyroid. Leukemia and lymphoma also occur in the eye. Less than 10 percent of intraocular metastatic tumors are located in the anterior part of the eye.
Most patients with iris metastasis either have visible cancer or secondary glaucoma. Glaucoma can cause foggy vision, halos around lights and headaches (brow aches). It is these "symptomatic" patients that come to or are sent for ophthalmic examination.
Most patients have a history of cancer or are found to have a primary source of tumor (on subsequent examination). It is important to perform complete systemic survey when intraocular metastasis is suspected. This examination should include radiographic imaging (staging) with whole body PET/CT and or computed radiographic imaging of the chest and abdomen. Consultation with a medical oncologist is warranted.
Eighteen percent of patients will be found to have no detectable primary cancer. Many of these tumors will later be found to be from the lung (particularly in men). In cases where no primary cancer is found, the intraocular tumor becomes the only tissue that can be used to direct the search for the primary site. Therefore, it is best to find the primary site before treating the intraocular tumor.
Biopsy techniques include: fine-needle aspiration biopsy, transcorneal tumor excision, and the Finger Iridectomy Technique (FIT).
Anterior uveal metastases can be difficult to manage. Depending upon the stage of the disease and the overall health of the patient, prompt external beam irradiation may offer the best hope to prevent tumor-related glaucoma and a blind painful eye. Thankfully, symptomatic anterior segment metastases are much less common than choroidal metastasis.
Note* Always dilate and examine both eyes. Metastases can be both bilateral and multifocal. Computed tomography or magnetic resonance imaging of the brain and lungs should be performed due to a high incidence of concurrent metastases.