When the lung reaches the eye: Ocular metastasis from large-cell neuroendocrine carcinoma

Dear Editor, The reported incidence of ocular metastases from lung cancer ranges from <1% for symptomatic cases to approximately 7%, when asymptomatic patients are included through prospective screening.[1] This discrepancy suggests that many ocular metastases remain clinically silent and undiagnosed. Despite that ocular metastases are the most common intraocular malignancies in adults occurring in up to 10% of patients with systemic cancer.[2] We present the case of a 51-year-old female patient diagnosed with large cell neuroendocrine carcinoma (LCNEC) of the lung, staged as T4N3M1c (stage IVB) according to the 8th edition of the TNM classification, with ALK rearrangement and PD-L1 expression of 0%. Despite the start of chemotherapy, approximately 2 months after the onset of symptoms, she developed complaints of blurred vision. Inspection revealed abnormalities in the left eye [Figure 1]. She was evaluated by an ophthalmologist, who on slit-lamp examination identified a 5 mm × 10 mm neovascularized mass in the anterior chamber of the left eye [Figure 2]. Ocular ultrasound was compatible with a solid metastasis of apparent uveal origin, with no identifiable extension. Indication was given for surveillance and conservative treatment. Disease progression led to patient’s death approximately 6 months after diagnosis.Figure 1: Left eye of the patientFigure 2: Ocular metastasis on slit-lampOcular metastases from LCNEC of the lung are extremely rare. Only a small number of such cases have been reported in the literature, with metastases to the iris or ciliary body being particularly uncommon.[3,4] In one case, a 70-year-old woman with ocular pain and photophobia was found to have a mass involving the iris and ciliary body, ultimately diagnosed as metastatic LCNEC of the lung following fine needle aspiration biopsy.[4] Lung cancer is one of the most common sources of ocular metastases, involving the choroid in approximately 88% of cases, while iris and ciliary body metastases occur less frequently—around 9% and 2%, respectively.[5] These can be asymptomatic or present with varying symptoms depending on the affected area. Management of ocular metastases is generally palliative and individualized, guided by the extent of systemic disease, patient condition, and location of the metastasis. However, even with aggressive multimodal therapy, prognosis remains poor, underscoring the need for a multidisciplinary, patient-centred approach focused on symptom control and quality of life. This case further emphasizes the importance of heightened awareness of ocular metastases, as earlier detection may help optimize clinical outcomes and preserve patient well-being. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.