Unusual Case of Secondary Glaucoma: Uveal Metastasis from Breast Cancer

Introduction: Uveal metastasis is the most common form of intraocular malignancy. Most uveal metastais occur in the posterior uvea, and iris metastasis are relatively rare. They may present as stromal nodules or ill-defined iris thickening, or they may be associated with atypical features such as pain or iridocyclitis. Objective and Methodes: We report the case of a 54-year-old patient whose ophthalmological examination revealed a relapse of her neoplastic disease. We emphasize the importance of a detailed medical history and a systematic general examination to establish an accurate diagnosis in the presence of any suspicious iris lesion that could be life-threatening. Results: A 54-year-old female presented with pain and blurred vision in her left eye. She had breast cancer, which was treated 4 years earlier with mastectomy, lymphadenectomy, and systemic chemotherapy. Ocular examination revealed a best corrected vision of 20/40 in the right eye and 20/20 in the left eye. Full extraocular motion was observed. The right pupil was slowly responsive to light, with 5 × 3-mm pinkish-white mass from 8 to 11 o’clock with intrinsic friable vessels. There was an intense anterior chamber inflammation with 3+/4+ cells associated with increased IOP. Fundus examination revealed large choroidal mass occupying the temporal quadrant. The magnetic resonance imaging (MRI) revealed thickness on iris of the right eye associated with choroidal metastasis and multiple brain metastasis. The patient was referred to oncology for reassessment, a general extension workup revealed also secondary pulmonary metastasis. Chemotherapy was initiated, but unfortunatlly the patient passed away 4 months later. Conclusion: This is a rare case of iris metastases associated with chroidal metastais from breast carcinoma. The rapid presentation should alert the clinician to suspect metastases in any unusual anterior segment lesion.