Most intraocular malignancies in adults are metastatic tumors. The most common primary cancers include lung and breast. Choroidal metastasis may be marked by vitritis, serous retinal detachment, and, occasionally, macular edema. These lesions are often bilateral and multifocal.
Anterior uveal metastasis may present with cells in the aqueous humor, iris nodules, neovascularization of the iris, and elevated IOP. Anterior chamber paracentesis may help confirm the diagnosis. Retinal metastases are extremely rare. Primary cancers metastatic to the retina include cutaneous melanoma (the most common), followed by lung, gastrointestinal, and breast cancer. Metastatic melanoma often produces brown spherules in the retina, whereas other metastatic cancers appear white to yellow and may result in perivascular sheathing, simulating a retinal vasculitis or necrotizing retinitis.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.