The 'silent' metastasis

Poster Details

First Author: R.Geraldes PORTUGAL

Co Author(s):    R. Laiginhas   A. Barros   J. Chibante   L. Duarte                    

Abstract Details


The purpose of the study is to present the unusual symptomatic presentation of an ocular metastasis of a 61-year-old male diagnosed with a pulmonary adenocarcinoma.


Centro Hospitalar Entre o Douro e o Vouga, Portugal.


Clinical case study.


The authors present the case of a 61-year-old male diagnosed with pulmonary adenocarcinoma located in the right upper lobe; classified as a stage IV cancer (T3N2M1a), referred to the ophthalmology emergency room, due to sudden loss of vision of the right eye (RE) with 3 weeks of evolution. On the ophthalmological exam, he denied pain and presented a normal ocular motricity without exophthalmia or alterations in the inspection and palpation of the orbit. He had a best corrected visual acuity of 20/200 on the RE and 20/20 on the left eye (LE).  Biomicroscopy exam was normal on both eyes. The fundoscopic exam revealed a “whitish” lesion producing a macular elevation on the RE; and no abnormal findings on the LE. The OCT showed protrusion with a slight increase in thickness of the retinal pigmented epithelium, without apparent disruption, with suprajacent neurosensorial retinal detachment. Fluorescein angiography revealed on the lesion no initial choroidal perfusion, late pooling, capillary dilatation and no intra-tumour circulation. The observed changes were suggestive of choroidal metastasis. The patient was referred to oncological therapeutic decision.


It was possible to identify a metastatic lesion of a primary lung tumour, where the only ocular symptomatology was a decrease in visual acuity. In this context, the lack of specificity of ophthalmological symptoms present in patients diagnosed with carcinoma of internal organs should also alert us to the possibility of ocular metastasis and, therefore, raise awareness of this possible outcome both in the field of ophthalmology or other medical specialties that deal with these cases.

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