Ocular and optic nerve metastasis: diagnosis and treatment

ABSTRACT Introduction Metastasis to the orbit and eyeball are rare yet significant indicators of widespread malignancy that can profoundly affect the quality of life and overall prognosis. Within the orbit, anterior metastasis is more common than posterior orbital metastasis. Of the intraocular sites, the choroid is the most prevalent site for metastasis, followed by the retina, optic nerve, and iris. Areas covered The review covers clinical manifestations, imaging features and various treatment options for managing orbital and intraocular metastasis. Expert opinion A high degree of suspicion, along with a thorough investigation of important historical aspects, careful clinical assessment, and meticulous interpretation of imaging studies such as ultrasonography, optical coherence tomography, fundus fluorescein angiography, and indocyanine green angiography, is necessary for establishing an early and accurate diagnosis of intraocular metastasis. A multidisciplinary approach involving a retina specialist, ocular oncologist, radiologist, pathologist, medical oncologist, surgical oncologist, radiotherapist, and pain management specialists will assist in early identification, prompt initiation of treatment, and improvement of quality of life for affected patients. Unlike many other reports that focus solely on either orbital or choroidal metastasis, this review presents a comprehensive overview of both intraocular and orbital metastasis.