Fig. 28.1

Two pale choroidal metastases above the macula.

Fig. 28.2

Pale metastasis on the optic disc, with telangiectasia, hemorrhage and lipid leakage.

In most patients, the priorities of treatment are symptom relief and management of the primary malignancy. When choroidal metastases are asymptomatic and the patient is already receiving systemic treatment, the initial management is to record baseline measurements (e.g. fundus photographs and visual fields).

Radiotherapy Some secondaries, e.g. associated with carcinoma of the breast,

are responsive to external beam radiotherapy, with tumor resolution and vision improvement. Other treatment modalities may include medical therapy or focal laser treatment. Potential adverse effects of radiotherapy include damage to the eyelid, retina or optic nerve.

Surgery Enucleation is occasionally performed to relieve the patient of a painful, blind eye.

Choroidal and optic nerve metastasis