Iris metastases from small cell lung carcinoma

A 58-year old, Caucasian male, chronic smoker, presented to the emergency department with a two-month history of progressive red painful visual loss of the left eye. He had been diagnosed months before with stage IV small cell lung carcinoma, with multiple systemic metastases (lymph nodes, thyroid, kidneys, adrenal, and brain), and was under palliative chemotherapy. Left best-corrected visual acuity was 20/200. Slit-lamp examination revealed an exceptional clinical picture, with an edematous cornea, an obvious anterior chamber inflammatory reaction (Tyndall 3+ cells) and an inferior, vegetant mass with intrinsic friable vessels (Fig. 1 A, arrow), as well as multiple whitish nodular, solid iris lesions (Fig. 1 A and B, black arrowhead). Rubeosis iridis was present (Fig. 1 B, blue arrowhead), and intraocular pressure was high (31mmHg). Ultrasound biomicroscopy confirmed an iridociliary mass with medium-high internal reflectivity, extending through the anterior chamber and invading the iridocorneal angle (Fig. 1 C, arrow), and several isoechoic iris nodules (Fig. 1 D, arrowheads). Based on the aforementioned signs and the patients’ medical history, a clinical diagnosis of metastatic eye disease was made. Considering the advanced stage of the primary disease and the patients’ poor performance status, ophthalmic management prioritized intraocular pressure and pain control, with topical hypotensive agents, cycloplegics and corticosteroids. After 3 months of follow-up, the patient is stable and symptomatically controlled.