Metastatic Tumors of the Uvea

Abstract

Tumor metastasis to the eye is a rare phenomenon. Some malignant tumors such as breast and lung cancer are most frequent primary tumors to metastasize to the eye. Ocular metastasis may present in the setting of a known primary malignancy or in absence of a known primary tumor. In all suspected cases of metastases, a thorough work up is necessary to diagnose the primary malignancy. Intraocular metastasis is predominantly uveal in location, most frequently to the choroid but also to the iris and ciliary body, with rare exception of retinal metastasis. The presenting symptoms may vary according to the site of tumor metastasis within the uvea. The differential diagnosis of uveal metastasis includes primary ocular tumors such as amelanotic uveal melanoma, choroidal hemangioma, scleritis, and inflammatory granuloma. Primary tumors are often unifocal while metastatic tumors tend to be multifocal or bilateral. Discussion with the primary oncologist may help further guide diagnostic imaging. Biopsy of the uveal metastasis is considered, if the initial imaging studies are inconclusive. In general, the treatment is guided by the type of primary tumor and extent of metastasis within the eye and elsewhere. Treatment decisions are also made in consultation with the primary oncologist. Overall survival prognosis depends on the nature of primary malignancy, extent of spread, and available treatment options as determined in consultation with the primary oncologist.