Talk for Trivandrum Oncology Club

1. Metastasis from breast
cancer to the eye
Mathruspandanam Online Awareness program
by
TOC, Vanitha, Swasthi & LNCPE
Dr. Kavitha Devin DO, DNB

2. Introduction
Breast cancer is the most common cancer
among American women after skin cancer.
Today, about 1 in 8 women (12%) will
develop breast cancer in her lifetime. Breast
cancer is the second-leading cause of cancer
death in women.

3. Ocular Metastasis
In patients with a previous history of breast cancer who complain even of mild
ophthalmologic symptoms such as local pain, periorbital edema, it is important to
consider ocular or orbital metastatic disease. Ocular metastasis from breast cancer
is usually preceded by metastasis to other organs, primarily the lungs. Prospective
screening has shown that choroidal metastases are found more frequently in
patients already known to have metastasis in other organ systems. At the time of
diagnosis of ocular metastasis, 85% of patients also have pulmonary involvement

4. Symptoms
Most patients with choroidal metastasis have no symptoms.
However, if the metastasis is on the eye or eyelids, it may be
visible.
If the metastasis is located behind the eye, the eyeball may be
visibly displaced out or to the side.
If the metastasis is within the eye, metastasis patients can
have symptoms of flashing lights, floating spots or distortion of
their vision.

5. DIAGNOSIS
In that most patients with ocular metastasis have either a
known primary cancer and/or metastatic tumors in other
parts of their body; a careful medical history is important.
If an eye cancer specialist suspects ocular metastasis, both
eyes and orbits should be examined because ocular
metastases can be both bilateral and/or multifocal.
Choroidal metastasis is usually non-pigmented (except
metastatic melanomas), and has typical ultrasound and
angiographic patterns. Choroidal metastasis is usually poorly
circumscribed and can cause retinal detachments.

6. TREATMENT
Treatment depends on the type of
metastasis and its primary source.
Treatment options often include
chemotherapy, immunotherapy and
radiation therapy.

7. Site Incidence Symptoms Signs
Iris 9% Asymptomatic Iris mass (usually
superior)
Blurred vision Uveitis,
Glaucoma
Pseudo-hypopyon
Ciliary body 2% Asymptomatic Dome-shaped or sessile
mass (usually inferiorly)
Blurred vision, pain Uveitis
Glaucoma
Sectorial cataract
Lens subluxation
Shallow anterior chamber

8. Site Incidence Symptoms Signs
Vitreous Rare Floaters Vitritis
Blurred vision
Choroid 81% Asymptomatic Yellow placoid lesions
(usually superior and
temporal)
Blurred vision Serous retinal
detachment
Metamorphopsia Alteration of retinal
pigment epithelium
Pain, diplopia (rare) Choroidal detachment
Glaucoma
Retinal Rare Blurred vision Vitritis
Floaters Black infiltrative retinal
mass with retinitis-like
appearance

9. Site Incidence Symptoms Signs
Optic disc 5% Asymptomatic Diffuse or localized disc swelling
Blurred vision Disc haemorrhages
Disc oedema
Extraocular Rare Diplopia Proptosis or enophthalmos
Heterotropia
Cerebral Rare Field defects Strabismus
Hemineglect Field loss
Abnormal colour vision
Blurred vision
Diplopia

10. How cancer treatment
affects the eye & vision.
Though not a common side effect, breast cancer
treatment may affect your eyes, including your
vision.
Eye problems may include:
• red, itchy, or dry eyes
• watery eyes
• conjunctivitis (pink eye)
• blurry or double vision
• seeing dark spots

11. General Precautions
• Wash your hands often.
• Don’t rub or touch your eyes unless you are cleaning your eye area.
• Discontinue contact lens use till the treatment is over.
• Supplement your tears with over the counter artificial tears up to 6x
daily. Using these artificial tears once a day just isn’t enough to provide relief.
• See your eye doctor quickly if you notice any changes to your vision
while you are undergoing treatment.
• Schedule your eye appointment with your eye doctor to review in
office imaging of your retina to monitor any retinal changes, OCT imaging is
available to document any macular problems. Also, your doctor can discuss
other dry eye treatments available.

13. Thank you.