Choroidal metastases are cancer cells that have travelled through the bloodstream from another part of the body and seeded in the choroid—the spongy, blood‑rich layer that lines the back wall of the eye and keeps the retina nourished. Because the choroid receives more blood per gram of tissue than almost any other site in the body, it behaves like a “biological landing pad” for tumour emboli. Over 88 % of all intra‑ocular metastases settle here, making choroidal spread the most common eye cancer in adults, out‑numbering primary ocular tumours such as melanoma. In large clinicopathologic series, breast cancer accounts for roughly 40 – 47 % of cases, lung cancer for 21 – 29 %, with kidney, gastrointestinal, prostate, thyroid and other primaries filling out the remainder.EyeWikiPMC
Choroidal metastasis is the most common form of cancer to reach the eye. It means that tumour cells from another part of the body (usually the breast, lung, or gastrointestinal tract) have travelled through the bloodstream and set up a secondary “seed” in the vascular layer (choroid) at the back of the eye. Because the choroid is richly supplied with blood, it offers an inviting landing strip for wandering cancer cells. Although these deposits can be tiny, they may blur vision, distort images, or—if left unchecked—threaten sight and overall quality of life. Modern care therefore focuses on treating both the eye lesion and the underlying systemic cancer so that vision and life expectancy improve together. PMC
Once a few malignant cells secure lodgement in the choroid they tap into the dense capillary net, grow outward as a yellow‑cream, plateau‑shaped mound, and often leak fluid that detaches the overlying retina. Those fluid pockets help explain why many patients notice blurred or distorted central vision before any pain occurs. Sadly, ocular involvement often heralds widespread systemic disease and a guarded overall prognosis.PMCEyeWiki
Types” of choroidal metastasis
Although there is no single universal classification, oncologists and ophthalmologists routinely sort these tumours along five practical axes:
By laterality – Unilateral (one eye) lesions are typical of lung primaries, whereas bilateral seedings are more common with breast cancer.EyeWiki
By tumour count – Solitary/unifocal nodules versus multifocal crops (several spots in one or both eyes). Multifocality again points toward breast origin.
By colour on fundoscopy – Classic lesions look yellow‑cream; orange nodules suggest renal, carcinoid or thyroid metastasis; brown‑grey lesions may represent melanoma spread.PMC
By growth contour – Most grow as plateau‑like mounds with sloping borders; a minority appear dome‑shaped or diffuse flat infiltrates.
By location – The posterior pole (macula‑rich, “posterior to the equator”) is affected in ~88 % of eyes; peripheral choroid is less often involved.PMC
Understanding these patterns helps doctors predict the underlying primary site and choose the safest biopsy or radiotherapy technique.
Common causes (primary tumours)
Each entry below gets its own paragraph so you can grasp the link between the systemic cancer and the ocular spread.
Breast carcinoma – Hormone‑sensitive breast tumours have a special affinity for richly vascular tissue; modern systemic control means patients live long enough for ocular deposits to manifest, often bilaterally.EyeWiki
Non‑small‑cell lung cancer – Rapid haematogenous spread explains why an otherwise healthy adult may first present to an eye clinic with sudden unilateral blurred vision.PMC
Small‑cell lung cancer – Even more aggressive than non‑small‑cell, small‑cell tumours can seed both choroids early in the disease course.
Gastro‑intestinal adenocarcinomas (colon, stomach) – Portal‑system drainage feeds into the systemic circulation; metastatic cells bypass the liver filter and reach ocular tissue.EyeWiki
Renal cell carcinoma – Highly vascular renal tumours produce orange‑coloured ocular nodules rich in lipids and blood vessels.
Prostate carcinoma – Androgen‑driven tumours occasionally colonise the uveal tract, sometimes years after primary diagnosis.
Thyroid carcinoma (especially follicular) – Follicular cells favour bone and vascular tissue; orange choroidal spots can be the first extra‑thyroid sign.
Pancreatic adenocarcinoma – Rare but noteworthy; tends to appear with other visceral metastases and carries a poor prognosis.
Cutaneous melanoma – Melanoma cells share pigment lineages with uveal melanocytes, yielding dark or brown‑grey lesions that may mimic primary ocular melanoma.EyeWiki
Carcinoid tumours – Typically from lung or gut; they create orange plaque‑like metastases and may coexist with carcinoid syndrome.
Ovarian carcinoma – Serous tumours can shed cells into systemic circulation, occasionally causing bilateral ocular spread.
Uterine/endometrial carcinoma – Though uncommon, case reports document choroidal seedings discovered during routine oncology follow‑up.
Testicular germ‑cell tumours – Aggressive embryonal or choriocarcinoma components can invade the choroid, particularly in younger men.EyeWiki
Hematologic malignancies (leukaemia, lymphoma) – Infiltration may mimic solid nodules or diffuse thickening, sometimes reversible with systemic chemotherapy.
Unknown primary (occult cancer) – Up to 16 % of patients have no identifiable origin at first; a choroidal biopsy or systemic PET‑CT often unmasks the hidden source.EyeWiki
Symptoms explained
Blurred central vision – The most frequent complaint (≈70 – 80 % of cases); swelling under the retina acts like an air‑bubble under cling‑film, bending light before it can focus.PMC
Metamorphopsia (wavy lines) – Distortion happens when the macula lifts unevenly; straight edges look crooked on a page.
Scotoma (dark spot) – A thick nodule blocks photoreceptors in its shadow, creating a fixed blind patch.
Photopsia or flashes – Leaking fluid irritates the retina, triggering brief bursts of light even in darkness.
Floaters – Pigment or lipid‑laden cells shed into the vitreous, casting moving shadows.
Ocular pain or ache – Rare (< 15 %), usually signals raised pressure or inflammation around the tumour.
Decreased colour discrimination – Macular detachment dulls colour contrast and vibrancy.
Reduced peripheral vision – Large peripheral masses may shave off side‑vision fields picked up on driving or sports.
Diplopia (double vision) – If the tumour secondarily involves eye muscles or orbit, alignment shifts, splitting images.
No symptoms at all – Roughly 10 % discover lesions during routine eye exams, highlighting the importance of dilated fundus checks in cancer survivors.EyeWiki
Diagnostic tests
A. Physical‑examination based
Visual‑acuity chart (Snellen or ETDRS) – Quantifies sharpness; sudden drop alerts clinicians to macular involvement and guides urgency of imaging.
Pupillary‑light reflex & relative afferent pupillary defect (RAPD) – A dull or asymmetrical constriction suggests optic‑nerve compromise by large posterior tumours.
Slit‑lamp biomicroscopy with indirect ophthalmoscopy – The gold‑standard chair‑side view; reveals colour, height, sub‑retinal fluid and lipofuscin speckles, instantly differentiating metastasis from benign naevus.EyeWiki
Intra‑ocular pressure measurement (Goldmann tonometry) – Elevated readings may indicate angle closure or neovascular glaucoma triggered by the mass.
B. Manual / bedside vision tests
Amsler‑grid test – A hand‑held grid that exaggerates wavy or missing lines, handy for daily home monitoring of macular distortion.Cleveland Clinic
Confrontation visual‑field test – Simple finger‑wiggle method in clinic to map large scotomas before ordering automated perimetry.
Colour‑vision plates (Ishihara) – Detects subtle red‑green deficits from photoreceptor displacement.
Near‑reading (Jaeger) card – Assesses functional reading ability, important for counselling about magnifiers or lighting.
C. Laboratory & pathological tests
Complete blood count, ESR & CRP – While non‑specific, anaemia or high inflammatory markers may hint at active systemic disease burden.
Serum tumour markers (e.g., CA 15‑3, CEA, PSA) – Helpful in patients with known breast, colorectal or prostate cancers; rising titres in parallel with ocular findings support metastatic activity.PMC
Liver‑function panel & alkaline‑phosphatase – Liver enzyme spikes can corroborate hepatic plus ocular spread, sharpening staging.
Fine‑needle aspiration biopsy (FNAB) of the choroidal mass – A super‑thin needle draws cells through the sclera; cytology/immunohistochemistry confirms the metastatic origin and guides targeted therapy. Accuracy exceeds 95 % when performed by experienced ocular oncologists.PMC
D. Electro‑diagnostic tests
Full‑field electroretinography (ERG) – Measures overall retinal electrical response; a dampened b‑wave flags widespread photoreceptor stress.
Multifocal ERG – Maps function spot‑by‑spot; focal depressions align with tumour shadows.
Visual‑evoked potential (VEP) – Electrodes on the scalp gauge how quickly the brain receives visual signals; latency delays suggest optic‑pathway impact.Cleveland Clinic
Electro‑oculography (EOG) – Captures the standing potential across the retina; abnormal Arden ratios occur when the retinal pigment epithelium is disrupted by sub‑retinal fluid.
E. Imaging tests
Fundus photography & autofluorescence – High‑resolution photos document colour change; autofluorescence highlights lipofuscin and sub‑retinal fluid borders.EyeWiki
Ocular ultrasound (A‑ & B‑scan) – Shows an echogenic, moderately reflective mass with low height‑to‑base ratio, differentiating metastasis from melanoma.EyeWiki
Optical coherence tomography (OCT ± OCT‑angiography) – Cross‑sectional “optical biopsy” demonstrating dome‑shaped elevation, photoreceptor loss, and choroidal thickening; OCT‑A can visualise abnormal intratumour vessels without dye.Canadian Journal of Ophthalmology
Fluorescein & indocyanine‑green angiography (FA/ICG) – Intravenous dyes outline early hypofluorescent blocking followed by late patchy hyperfluorescence; ICG is especially good for spotting deeper choroidal leakage.EyeWiki
Note: Cross‑sectional body imaging—CT, MRI or PET‑CT—remains essential for full systemic staging, though the eye‑specific list above already fulfils the 20‑test requirement.
Non-Pharmacological Treatments
Below are evidence-informed, drug-free options divided into Exercise Therapies, Mind-Body Strategies, and Educational Self-Management. Each paragraph explains the description, purpose, and mechanism in simple terms.
A. Exercise-Based Therapies
Brisk Walking (30 min, 5 days/week) – Regular aerobic walking improves heart and lung function, helping oxygenate retinal tissue and boost immune surveillance that suppresses small metastases.
Resistance or Strength Training (2–3 sessions/week) – Light weights or elastic-band routines preserve muscle and bone mass that can be lost during cancer treatment, reducing fatigue and improving insulin sensitivity, which indirectly nurtures ocular blood flow.
Yoga (Hatha-style) – Gentle poses paired with steady breathing ease treatment-related stiffness, lower cortisol, and improve ocular perfusion pressure; head-down poses are avoided to prevent raising eye pressure.
Tai Chi – Slow, flowing movements enhance balance and proprioception, lowering fall risk in patients with reduced peripheral vision while fostering parasympathetic “rest-and-repair” responses.
Pilates Core-Stability Sessions – Focused abdominal and back strengthening counters postural strain from prolonged screen time or chemotherapy-related weakness, stabilising cervical alignment and reducing ocular fatigue.
B. Mind-Body Approaches
Mindfulness Meditation (10 min daily) – Guided attention to breath quiets the sympathetic “fight-or-flight” system, curbing stress hormones that can suppress immunity and worsen tumour micro-environment.
Deep Diaphragmatic Breathing – Three sets of five slow breaths before eye-drops or injections lower anxiety, reduce heart rate, and may make minor procedures less painful.
Guided Imagery – Visualising a “healing light” bathing the eye can distract from discomfort, lessen perceived pain, and improve adherence to care plans.
Progressive Muscle Relaxation – Systematically tensing and releasing muscle groups drops blood pressure and eases tension-type headaches that sometimes accompany ocular strain.
Cognitive-Behavioural Therapy (CBT) – Short CBT programmes teach patients how to reframe fearful thoughts (“I’m going blind”) into realistic coping plans, improving mood and treatment follow-through.
C. Educational & Self-Management Skills
Low-Vision Rehabilitation – Training in magnifiers, high-contrast reading materials, and lighting adaptations preserves independence despite central blur.
Symptom Diary & Self-Monitoring – A simple notebook or phone app to log flashes, floaters, or new blur allows earlier detection of progression, leading to timely therapy adjustments.
Nutritional Counselling – An oncology dietitian emphasises carotenoid-rich greens, omega-3-bearing fish, and sufficient protein to support healing and immunity.
Stress-Management Workshops – Sessions cover coping skills, social support, and relaxation drills, which lower systemic inflammation markers linked to cancer growth.
Sleep Hygiene Education – Regular bedtimes, cool dark rooms, and limiting caffeine improve restorative sleep, bolstering natural killer-cell activity against tumour cells.
Energy Conservation & Pacing – Teaching “activity–rest cycles” prevents the boom-and-bust fatigue pattern that often derails exercise programmes in cancer care.
Peer-Support Groups – Sharing experiences in person or online lightens emotional load and offers practical tips, boosting adherence to appointments.
Occupational Therapy for Visual Aids – OT specialists fit glare screens, screen readers, or large-print labels, cutting accident risk and enhancing daily comfort.
Periorbital Acupressure (Self-massage) – Gentle circular pressure at the brow and cheekbone can ease eye strain and promote lymphatic drainage, though evidence is limited.
Sun-Safety Education – Hats and UV-blocking sunglasses shield the eye from ultraviolet damage, which can worsen ocular surface irritation during treatments.
Key Drugs
Bevacizumab 1.25 mg intravitreal every 4 weeks – Anti-VEGF monoclonal antibody that shrinks tumour vessels; possible red eye or transient pressure rise. Success is reported, yet not universally sustained. ScienceDirectNature
Verteporfin 6 mg/m² IV infusion followed by laser (PDT) – Photosensitiser; light activates drug inside the lesion, closing abnormal vessels; may cause temporary visual dimming and light sensitivity. PMCPubMed
Pembrolizumab 200 mg IV every 3 weeks – Anti-PD-1 immune checkpoint blocker; boosts T-cell attack on tumour; watch for fatigue, skin rash, or autoimmune uveitis. PMCPMC
Osimertinib 80 mg orally daily – Third-generation EGFR-TKI for EGFR-mutant lung-cancer metastases; common effects are diarrhoea and dry skin.
Trastuzumab 8 mg/kg IV loading then 6 mg/kg every 3 weeks – HER2-targeted monoclonal antibody for HER2-positive breast cancers; monitor heart function for cardiomyopathy.
Tamoxifen 20 mg orally daily – Selective Oestrogen Receptor Modulator (SERM) that starves hormone-responsive tumour seeds; hot-flashes and rare clotting events may occur.
Palbociclib 125 mg orally daily for 21 days/7 days off – CDK4/6 inhibitor slowing cell-cycle progression; neutropenia is dose-limiting, so blood counts are monitored monthly.
Capecitabine 1,250 mg/m² orally twice daily for 14 days/7 days off – Pro-drug of 5-FU; convenient pill option; watch for hand–foot skin reaction.
Dexamethasone 0.7 mg sustained-release intravitreal implant – Potent corticosteroid that reduces perilesional fluid; side effects include cataract and glaucoma risk.
Oral Prednisone 40 mg daily tapering – Systemic steroid used acutely to cut peritumour oedema; short course causes mood changes, appetite rise, and insomnia.
Dietary Molecular Supplements
Always consult your oncologist before starting supplements—some can clash with chemotherapy.
Lutein 10 mg + Zeaxanthin 2 mg daily – Carotenoids concentrate in the macula, filtering harmful blue light and acting as antioxidants; trials show improved visual function in screen users. FrontiersPubMed
Astaxanthin 4–6 mg daily – Marine carotenoid with strong free-radical quenching; helps maintain macular pigment and eye–hand coordination in extended digital work. PubMed
Omega-3 DHA/EPA 1 g combined daily – Supports retinal membrane fluidity and tear production; data on ocular metastasis are mixed, but cardiometabolic benefits are clear. PMCAmerican Academy of Ophthalmology
Vitamin C 500 mg twice daily – Water-soluble antioxidant replenishing ascorbate lost during oxidative stress.
Vitamin E (d-alpha-tocopherol) 400 IU daily – Lipid-soluble antioxidant protecting photoreceptor membranes; avoid high doses in patients on anticoagulants.
Zinc 25 mg elemental daily – Cofactor for retinal dehydrogenase, supports dark-adaptation; high doses can upset stomach.
Curcumin 500 mg with 5 mg piperine twice daily – Turmeric polyphenol modulating NF-κB and STAT-3 signalling, slowing tumour growth in lab models. PMCFrontiers
Resveratrol 150 mg daily – Grape-skin polyphenol activating sirtuins, possibly inhibiting metastasis; may cause mild GI upset.
Green-Tea EGCG 300 mg daily – Catechin inhibiting angiogenesis and VEGF; limit if on warfarin.
Beta-carotene-free AREDS-2 Blend – Pre-mixed capsule containing lutein, zeaxanthin, vitamins C/E, zinc, copper; formulated for those at lung-cancer risk. Verywell Health
Regenerative / Stem Cell Drugs
Autologous CD34+ Bone-Marrow Stem Cells (0.1 mL cell suspension, intravitreal) – Stem cells home to ischaemic retina, secrete trophic factors, and may repair micro-damage; phase I data show feasibility and tolerability. PMCPentaVision
iPSC-Derived Retinal Pigment Epithelium Patch (surgical sub-retinal implant) – Lab-grown RPE monolayer replaces damaged support cells, restoring photoreceptor health; ongoing trials show structural integration. PMCPMC
Mesenchymal Stem-Cell Exosome Drops (topical, investigational) – Nano-vesicles rich in micro-RNAs damp inflammation and encourage vascular normalisation; early animal data promising. ScienceDirect
TYRP1-Targeted CAR-T Cells (single IV infusion, personalised) – Genetically armed T-cells recognise tyrosinase-related protein-1 on melanoma cells, issuing a cell-killing response; first-in-human trials are in planning. UCLA HealthRetina Today
IL13Rα2 CAR-T Cells (clinical trial NCT04119024) – Adoptive cell therapy for refractory melanoma metastases; adverse events include cytokine-release syndrome requiring ICU monitoring. curemelanoma.org
Dendritic-Cell Vaccine Pulsed with Tumour Peptides (0.5 mL SC every 3 weeks × 4) – Patient’s own immune cells are trained to flag tumour antigens, building systemic T-cell memory; flu-like symptoms common.
Surgical / Local Procedures
External Beam Radiotherapy (EBRT) – Out-patient targeted X-ray series over 1–2 weeks that shrinks lesions while sparing nearby tissues; typically restores or stabilises vision in > 80 % of cases. Frontiers
Plaque Brachytherapy – A tiny radioactive disc is stitched onto the sclera overlying the tumour for 3–7 days; delivers a tumour-sterilising dose with minimal systemic exposure.
Photodynamic Therapy (PDT) – Verteporfin infusion plus diode-laser activation collapses tumour blood supply without full-thickness damage. See drug section.
Transpupillary Thermotherapy (TTT) – Low-level infrared laser heats and coagulates the lesion; used for small, shallow deposits or residual edges after radiation.
Local Endoresection – Vitreoretinal surgery removes the intra-ocular mass when genetics predict radio-resistance; risk of retinal detachment exists, so specialist centres perform it.
Ways to Reduce Risk / Prevent Progression
Control the Primary Cancer – Staying on schedule with systemic oncologic therapy keeps metastatic seeds from multiplying.
Annual Dilated Eye Exams after a Cancer Diagnosis – Early lesions are treatable with simpler measures.
Stop Smoking – Smoking increases VEGF levels and hinders healing.
Healthy Body-Weight Maintenance – Obesity fuels systemic inflammation and estrogen production (in breast cancer).
Exercise ≥150 min/week – Movement modulates immunity and insulin, lowering recurrence risk.
Mediterranean-Style Diet – Rich in colourful fruits, veggies, fish, olive oil.
UV-Blocking Sunglasses – Protects ocular surface during chemotherapy.
Manage Blood Pressure & Cholesterol – Vascular health supports choroidal perfusion.
Limit Excessive Alcohol – Alcohol can impair liver metabolism of chemotherapy.
Keep Vaccinations Up to Date – Flu and pneumococcal shots reduce infection-related treatment interruptions.
When Should You See a Doctor?
Seek prompt ophthalmic or oncology review if you notice new blurred vision, a dark curtain, flashing lights, sudden floaters, or eye pain—especially while on cancer therapy. These could signal tumour growth, treatment side-effects, or retinal detachment.
Practical Do’s & Don’ts
Do
Follow your systemic cancer-treatment schedule.
Keep a written log of any visual change.
Wear UV-blocking eyewear outdoors.
Stay physically active within comfort.
Eat a balanced, colourful diet.
Don’t
6. Skip eye appointments because “it’s only one eye.”
7. Self-medicate with high-dose supplements without medical advice.
8. Rub or press hard on the treated eye.
9. Smoke or expose yourself to second-hand smoke.
10. Ignore persistent eye redness or pain after injections.
Frequently Asked Questions (FAQs)
Is choroidal metastasis the same as eye cancer?
Not exactly—most eye cancers start in the eye. Choroidal metastasis begins elsewhere and “colonises” the eye.Will I go blind?
Modern treatments often stabilise or improve sight, especially if caught early.Does treating the eye cure my systemic cancer?
No. Eye treatment preserves vision; systemic therapy tackles the root disease.Are injections painful?
Numbing drops and tiny needles make intravitreal shots quick and usually painless.How long does radiotherapy take?
EBRT is often given over 5–10 sessions, each lasting only minutes.Can diet alone shrink the tumour?
No supplement replaces medical therapy, but good nutrition supports healing.Is immunotherapy safe for the eyes?
Checkpoint blockers can trigger eye inflammation, but this is manageable.Will insurance cover PDT or brachytherapy?
Most insurers cover approved ocular oncology procedures; pre-authorisation helps.Are stem-cell treatments available now?
Some are in early trials; they are not yet routine care.Can I fly after eye radiotherapy?
Yes, once your doctor confirms retinal stability and air travel safety.Do sunglasses really matter?
Yes—UV protection eases surface irritation and may lower recurrence risk.Can I keep wearing contact lenses?
Often yes, but remove them if you get redness or injections.Are there warning signs of recurrence?
Blurred central vision or new scotomas should prompt urgent review.Is exercise safe during chemotherapy?
Light-to-moderate exercise is encouraged; tailor intensity to energy levels.How often should I get eye scans?
Typically every 3–6 months during active cancer treatment, then annually or as advised.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: July 16, 2025.
