Isolated ocular metastases from lung cancer

Case presentation and summary A 60-year-old man with a 40-pack per year history of smoking presented to multiple ophthalmologists with complaints of decreased vision and redness of the left eye. He was eventually evaluated by an ophthalmologist who performed a biopsy of the anterior chamber of the eye. Histologic fi ndings were consistent with adenocarcinoma of lung primary (Figures 1 and 2). After the diagnosis, a chest X-ray showed that the patient had a left lower lung mass. Th e results of his physical exam were all within normal limits, with the exception of decreased visual acuity in the left eye. Th e results of his laboratory studies, including complete blood count and serum chemistries, were also within normal limits. Imaging studies – including a computed-tomography (CT) scan of the chest, abdomen, and pelvis and a full-body positron-emission tomography–CT scan – showed a hypermetabolic left lower lobe mass 4.5 cm and right lower paratracheal lymph node metastasis 2 cm with a small focus of increased uptake alone the medial aspect of the left globe (Figures 3 and 4). An MRI orbit was performed in an attempt to better characterize the left eye mass, but no optic lesion was identifi ed. A biopsy of the left lower lung mass was consistent with non–small-cell lung cancer (NSCLC). Aside from the isolated left eye metastases, the patient did not have evidence of other distant metastatic involvement.