Learning that cancer may have reached the eye is hard news, and it often comes in the middle of treatment for another cancer. A choroidal metastasis is a secondary tumor: cancer cells that have traveled through the bloodstream from elsewhere in the body and settled in the choroid, the layer of blood vessels beneath the retina. It is not a new eye cancer, and it is treated as part of the original disease.
Treatment can often stabilize or improve vision. This page, part of our eye cancer guide, explains the symptoms, the tests and how eye treatment is coordinated with your oncologist.
What is a choroidal metastasis?
The inside of the eye has no lymphatic channels, so cancer cells reach it through the blood, and most lodge in the choroid with its rich blood supply. In published series, 88% of metastases to the uvea (the eye's middle, pigmented layer) were in the choroid, 9% in the iris and 2% in the ciliary body. They can be single or multiple and are often found in both eyes.
Metastases are often described as the most common malignant tumor inside the adult eye, although some are never diagnosed; studies estimate that they develop in 2–9% of people with advanced carcinoma. Unlike uveal melanoma, which starts in the eye's own pigment cells, a metastasis consists of cells from the original cancer — a breast cancer deposit in the eye is still breast cancer.
Which cancers spread to the eye most often?
Breast and lung cancer together account for almost two-thirds of eye metastases. In a Wills Eye Hospital series of 1,111 patients with uveal metastases, the original cancers were:
| Original (primary) cancer | Share of patients |
|---|---|
| Breast | 37% |
| Lung | 27% |
| Unknown primary site | 16% |
| Kidney | 4% |
| Gastrointestinal tract | 4% |
| Skin melanoma, lung carcinoid, prostate | 2% each |
| Thyroid, pancreas | 1% each |
The pattern differs by sex: in an earlier series of 520 eyes, 68% of women with eye metastases had breast cancer, while lung cancer was the most common source in men (40%).
Can the eye be the first sign of cancer?
Yes. In about two-thirds of patients (67%) the original cancer is already known when the eye metastasis is found, but in 18% it is discovered only afterwards, when the eye findings prompt a search. This happens particularly with lung cancer: in one series, 44% of patients with a lung cancer eye metastasis had not yet been diagnosed with lung cancer when the eye problem appeared.
What are the symptoms?
About 90% of people with a choroidal metastasis notice symptoms. In published series these were:
- blurred vision (about 70%), often because fluid collects under the retina;
- flashes of light or floaters (about 12%);
- pain (about 7%).
On examination a typical choroidal metastasis is a creamy-yellow, flat or gently raised patch (yellow in 86% of cases), often with fluid beneath the retina (72%). Metastases in the iris or ciliary body can appear as yellow-white nodules, raise the eye pressure or cause bleeding in the front of the eye.
How is a choroidal metastasis diagnosed?
The diagnosis rests on your history, the appearance of the lesion and several imaging tests (multimodal imaging):
- Ultrasound shows a flat or gently raised mass with moderate to high internal reflectivity, unlike most melanomas, which look "hollow".
- Optical coherence tomography (OCT) often shows an irregular, "lumpy-bumpy" surface and fluid under the retina.
- Autofluorescence and indocyanine green angiography help separate a metastasis from other tumors.
- PET-CT, arranged with your oncologist, looks for other metastases or, if no cancer is known, for its source.
- Fine-needle aspiration biopsy is used when the primary cancer is unknown or the diagnosis remains uncertain.
See also how eye tumors are diagnosed.
Lesions that can look like a metastasis
Several conditions can imitate a metastasis: an unpigmented (amelanotic) melanoma or nevus, choroidal hemangioma, choroidal osteoma, posterior scleritis, uveal effusion, central serous chorioretinopathy, infection, bleeding and inflammatory nodules. Telling them apart matters because the treatments differ completely (see benign intraocular tumors).
How are eye metastases treated?
There is no single standard treatment. The plan depends on your general health, the activity of the cancer elsewhere, your systemic treatment, whether one or both eyes are affected and how much vision is threatened. It is agreed with your oncologist, aiming to protect sight and comfort with as little extra burden as possible.
| Option | Typically used for | What to expect |
|---|---|---|
| Systemic therapy (chemotherapy, hormonal, targeted or immunotherapy) | Patients starting or already receiving cancer treatment | Eye lesions may shrink along with other metastases; the eye is monitored closely |
| External beam radiotherapy | Metastases in both eyes or in several spots | Given over about 3–4 weeks; often reduces fluid under the retina |
| Plaque brachytherapy | A single metastasis | A small radioactive disc stays on the eye wall for about 3–4 days |
| Photodynamic therapy | Small metastases at the back of the eye | Often improves vision when fluid is present |
| Proton or stereotactic radiotherapy, thermotherapy, anti-VEGF injections | Selected situations | Chosen case by case |
| Removal of the eye | Only a painful eye that has lost its sight | Rarely needed |
As of September 2026, an investigational light-activated drug, bel-sar (belzupacap sarotalocan), is being tested in a phase 2 trial in choroidal metastases, with early data expected during 2026. It is not approved and is available only within clinical trials.
What does an eye metastasis mean for the outlook?
A metastasis in the eye usually means that the cancer has spread beyond its original site (stage IV). It does not mean that nothing can be done: eye treatment can often preserve vision, and some people live for years with metastatic cancer.
Published survival figures vary widely with the type of cancer. In a large series, 57% of patients were alive 1 year after the eye metastasis was diagnosed, 42% at 2 years and 24% at 5 years; 5-year survival was 92% for lung carcinoid tumors, 25% for breast cancer and 13% for lung cancer. These figures come largely from patients treated before many of today's targeted and immune therapies were available, so they may not reflect current outcomes. Your oncologist, who knows the full picture, can explain what they mean for you.
Care for eye metastases in Antalya
When you are living with metastatic cancer, time and energy are precious, so visits are kept efficient and coordinated with your oncology team. Prof. Türkoğlu confirms whether a lesion is a metastasis or a lookalike, records its size as a baseline and plans eye treatment with you and your oncologist. Radiotherapy is delivered together with radiation oncology teams, and systemic treatment stays with your medical oncologist.
If you are treated abroad, the first step can be a remote review of retinal photographs, OCT and ultrasound images with a recent oncology summary and PET-CT report. Radiotherapy can sometimes be given where your other cancer treatment takes place. Travel information is on our international patients page.
Frequently asked questions
What does it mean if cancer has spread to my eye?
It usually means that the cancer has spread through the bloodstream beyond its original site — metastatic or stage IV disease. It does not mean that your sight cannot be protected: eye metastases often respond to systemic treatment or local therapy. Your oncologist reviews the overall treatment while the eye specialist plans care for the eye.
Will I lose my sight?
Not necessarily. Systemic therapy, radiotherapy or photodynamic therapy often stabilizes or improves vision, especially when fluid under the retina is reduced. The result depends on the size and position of the metastasis — particularly whether it involves the macula or the optic nerve — and on the overall response to treatment.
Do I need a biopsy of the eye?
Usually not. When a cancer is already known and the imaging pattern is typical, the diagnosis can generally be made without one. A fine-needle aspiration biopsy is considered when no primary cancer has been found, or when the lesion could be something else, such as an unpigmented melanoma.
Can my cancer drugs treat the eye metastasis?
Often, yes. Chemotherapy, hormonal therapy, targeted drugs and immunotherapy can shrink eye metastases together with metastases elsewhere — when breast cancer has spread to the eye, for example, the treatment chosen for the breast cancer may also act on the eye lesion. If the lesion is small and away from the center of vision, your specialists may watch its response before adding local eye treatment.
Should I have eye checks if I have metastatic cancer?
Report any change in vision promptly, including blurring, distortion, flashes, floaters or a shadow. Some oncologists also arrange eye examinations for patients with advanced cancer who have no symptoms; ask your own team whether this is advisable in your situation.
Can an eye metastasis come back?
Yes. A treated metastasis can grow again, and new ones can appear in the same or the other eye. Follow-up therefore continues with both the eye specialist and the oncology team, at intervals that fit your overall treatment, and any new visual symptom should be reported without waiting for the next visit.
References
- EyeWiki (American Academy of Ophthalmology). Choroidal Metastases. eyewiki.org
- EyeWiki (American Academy of Ophthalmology). Iris and Ciliary Body Metastasis. eyewiki.org
- Aura Biosciences. [First-quarter 2026 financial results and business update, including the phase 2 trial of bel-sar in choroidal metastases]. Press release, 2026. ir.aurabiosciences.com
- Turkoglu EB, Lally SE, Shields CL. Choroidal sarcoid granuloma simulating prostate carcinoma metastasis. Retinal Cases & Brief Reports, 2017;11 Suppl 1:S226-S228. PubMed
- Bilgin AB, Apaydin KC, Unal M, Ilhan HD, Türkoğlu EB, Aydin N. A case report of bilateral choroidal metastases of epithelial carcinoma of pancreas. Arquivos Brasileiros de Oftalmologia, 2014;77(4):259-260. PubMed