Ocular metastasis from esophageal cancer: a systematic review and pooled analysis of individual-level case data

PURPOSE: Ocular metastasis from esophageal cancer is a very rare clinical entity, typically only described in isolated case reports. This systematic review describes the clinical features, diagnostic strategies, treatment modalities, and outcomes of this uncommon manifestation. METHODS: A systematic search of the literature in the PubMed/Medline and Scopus databases was conducted from database inception to January 25, 2026, focusing on adult ocular metastasis from esophageal cancer. RESULTS: Forty-one cases were identified (mean age 58.7 ± 10.5 years; male-to-female ratio 5.8:1). The most common presenting symptom was blurred vision (46.3%), followed by eye pain (26.8%), diplopia and ptosis (each, 14.6%), and floaters (9.8%). Impaired visual acuity was documented in 85.3% of the cases reported. The choroid was the most frequently involved site (43.8%), followed by the iris (31.3%) and then the retina (12.5%). Ocular metastasis was synchronous in 63.4% of cases and was the presenting manifestation in 29.3%. Additional systemic metastases were present in 80.5% of cases. External beam radiotherapy was the most common local treatment (68.3%), achieving visual improvement in approximately two-thirds of treated patients. Median overall survival was 6 months. CONCLUSIONS: Ocular metastasis from esophageal cancer is indicative of advanced systemic disease. Early recognition and prompt local therapy may preserve visual function and quality of life despite poor overall prognosis.