Metastatic disease

Metastatic disease involving the eye is usually associated with choroidal metastases. The commonest tumours implicated are lung and breast. Presentation is usually with visual loss and sometimes pain. This is an oncological emergency. Treatment with radiotherapy should usually be with a lateral field to the orbit giving 20 Gy in five fractions over a week. The field may be angled five degrees posteriorly to avoid the contralateral lens. However, the prognosis is usually poor and cataract is not an issue.

Widespread bone metastases may affect the eye. This can lead to ocular pain, diplopia, and exophthalmos. When this occurs it is usually due to a breast primary, but does also occur with lung and prostate cancers. Systemic treatment is often appropriate, although local radiotherapy may be helpful.

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