A 41-year old Asian female undergoing systemic chemotherapy with Eribulin for metastatic breast cancer to regional lymph nodes, lung, bone and brain was diagnosed with a left iris and ciliary body metastasis (Fig. 1 A). External beam radiotherapy (EBRT) to the eye and brain showed favourable iris tumour response (Fig. 1B). Unfortunately, systemic chemotherapy had to be discontinued 4 months after EBRT because of the COVID-19 pandemic. The left eye became progressively red and painful and examination showed a significant increase in the size of the lesion which now took up over a third of the anterior chamber (Fig. 1C). Intraocular pressure was normal. Treatment options included further EBRT to the eye or brachytherapy. She was rapidly restarted on Eribulin which led to a significant regression of the uveal metastasis (Fig. 1D) and resolution of ophthalmic symptoms.
Figure 1.
A. Left iris and ciliary body metastasis diagnosed at the moment of chemotherapy treatment. B. Regression of the lesion following external beam radiotherapy. C. Recurrence of the metastasis after stopping chemotherapy because of the first wave of COVID-19 pandemic. D. Regression of the intraocular mass once chemotherapy was resumed.
This case shows that careful observation is needed in ocular metastasis where treatment may be suspended for other reasons but a favourable outcome is possible by simply resuming previous treatment regimens.
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