When the Choroid Speaks First: Choroidal Metastasis

Abstract

Choroid is the most common intraocular metastatic site, presenting typically as yellow subretinal/choroidal lesions with rapid symptom onset and associated subretinal fluid. Breast and Lung primaries dominate etiologies, and ocular disease may occur even when systemic disease is under treatment. Multimodal imaging (fundus examination, ultrasonography, OCT ± angiography) guides diagnosis and response assessment. Management is individualized: systemic therapy is preferred when the disease is chemosensitive or treatment is being escalated; local therapies (external beam radiotherapy, plaque radiotherapy, photodynamic therapy, transpupillary thermotherapy, and intravitreal anti-VEGF) are considered for vision-threatening lesions, poor systemic control, or inadequate ocular response.
In chemotherapy-treated cancers, a unilateral choroidal metastasis should prompt coordinated ocular-oncology care aimed at preserving vision while respecting systemic prognosis and treatment timelines. Early imaging-based diagnosis and timely local therapy can provide meaningful visual benefit.