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Uveal Metastatic Tumors

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Clinical Ophthalmic Oncology

Abstract

The ophthalmologist may be the first physician to detect disseminating disease as uveal metastasis may be the first presenting symptom, particularly with breast cancer and adenocarcinoma of the lung. Autopsy studies have shown microscopically detectable uveal metastases in 9.3% of all fatal cancer cases. Although the estimated incidence of uveal metastasis is 20,000 patients per annum in the United States, most of these patients are probably never seen by an ophthalmologist as they may be asymptomatic. Metastatic tumors may occur anywhere in the uvea including the iris, ciliary body, and choroid. The vast majority of metastatic tumors, however, develop in the choroid at the posterior pole due to the increased vascular supply, whereas metastases to the iris are relatively rare. In the majority of patients with uveal metastases, a primary tumor is known from the history. Sarcomas very exceptionally metastasize to the uvea. Blurred vision, floaters, and photopsia are the key symptoms of choroidal metastasis and are related to the intraocular mass itself as well as the associated exudative retinal detachment. Metastatic tumors in the anterior uvea may induce episcleritis and enlarged sentinel vessels. Frequently, choroidal metastases are bilateral and multifocal, predominantly placoid shaped, pale, or yellowish with indistinct margins. Systemic workup is needed if there is no history of a primary tumor. A full-body PET/CT is helpful to detect an unknown primary tumor, and in cases with suspected breast carcinoma or lymphoma, an MRI of the brain is essential because of the well-known coincidence of uveal and cerebral metastases with these tumors. Intraocular biopsy of a suspected lesion is indicated when the diagnosis cannot be ascertained by other, less invasive procedures. The decision to treat uveal metastatic tumors is complex and is made in consultation with the oncologist and radiation oncologist.

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Authors and Affiliations

  1. Klinik fuer Augenheilkunde, Universitaetsklinikum Essen, Essen, Germany

    Norbert Bornfeld

  2. Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

    Arun D. Singh

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  1. Norbert Bornfeld
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  2. Arun D. Singh
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Correspondence to Norbert Bornfeld .

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Editors and Affiliations

  1. University of Oxford, Oxford, UK

    Bertil E. Damato

  2. Cole Eye Institute Cleveland Clinic, Cleveland, OH, USA

    Arun D. Singh

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Bornfeld, N., Singh, A.D. (2019). Uveal Metastatic Tumors. In: Damato, B., Singh, A. (eds) Clinical Ophthalmic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-17879-6_28

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  • DOI: https://doi.org/10.1007/978-3-030-17879-6_28

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