Because of its rich vascular supply, the choroid is the most common site for ocular metastasis. Choroidal metastases may be solitary or multiple and may affect one or both eyes. Typically they appear as creamy-white lesions, as seen in this patient with metastatic breast cancer. Associated leopard spotting may also be detected. Choroidal metastases are often subtle and difficult to detect with direct ophthalmoscopy and may require referral to an ophthalmologist if suspected or if visual loss or visual distortion develops. Treatment options include local radiation and chemotherapy.