Management of systemic malignancies metastatic to the eye and orbit

The past quarter century has seen a dramatic shift in the management of many neoplasms. Early detection combined with new chemotherapeutic and radiation modalities have improved the prognosis for most patients with cancer. Long-term survival and complete remission are becoming much more commonplace. With increasing frequency, the ophthalmologist is playing a vital role in diagnosing and treating lesions metastatic to the eye and orbit. Prompt detection can provide patients with access to systemic and local therapeutic modalities, reducing their ocular and overall morbidity. Among solid tumors, ocular metastases from lung and breast carcinoma remain the most common. Intraocular spread usually occurs in the posterior choroid as a creamy yellow infiltrate. Patients present with painless loss of vision. Orbital disease is less common, manifesting with symptoms of proptosis, palpable mass, and diplopia. These lesions are radiosensitive and will often respond with reduction or resolution of symptoms. Leukemia and lymphoma represent a spectrum of neoplastic disorders with different ocular presentations. In leukemia, intraocular findings secondary to anemia and thrombocytopenia are more common than actual leukemic infiltrates. Intraocular lymphoma can masquerade as a chronic uveitis. Lymphomas of the ocular adnexa commonly present with progressive proptosis or as a conjunctival pink mass. Histologic features, anatomic site of involvement, and staging are important prognostic criteria. Localized disease is treated with external radiation. In general, metastatic disease to the eye and adnexal structures is a poor prognostic indicator; nonetheless, cases of long-term survival are well documented. In concert with oncologists and radiation therapists, ophthalmologists play a central role in delivering directed treatment and significantly improving the quality of life for these patients.