Intraocular and Ocular Adnexal Metastases: A Comprehensive Review.

Background: Ocular metastases include both intraocular and ocular adnexal metastases. Although rare, they are important indicators of systemic malignancy and can even be the first sign of cancer. Breast and lung carcinomas account for the maximum number of cases; kidney, gastrointestinal tract, and cutaneous melanomas are less frequent primaries. The choroid is the most common site of metastasis because of its rich vascular flow. Literature on ocular metastases remains limited, necessitating a comprehensive understanding of their clinical behavior, diagnostic approach, and management. Summary: This review provides a comprehensive overview of the epidemiology, clinical features, and diagnosis of these lesions. Tumor spread primarily occurs via the hematogenous route, with organ-specific predilection explained by vascular and microenvironmental factors. Choroidal metastases are the most common intraocular presentation, while orbital involvement predominates among adnexal sites. Clinical manifestations vary widely; advances in ophthalmic multimodal imaging and intraocular biopsy techniques facilitate early detection of ocular metastases. Although systemic chemotherapy and radiotherapy remain the cornerstones of treatment, the advent of newer therapeutic agents like immunotherapy and targeted therapy has revolutionized the management of these malignancies. Local treatment options like plaque brachytherapy, local resection, and photodynamic therapy are used in selective cases. Emerging techniques, including liquid biopsy and targeted molecular therapies, are expanding treatment possibilities. Key Messages: Ocular metastases serve as important indicators of systemic cancer; they may precede the diagnosis of the primary malignancy, requiring prompt recognition. A high index of suspicion, early recognition through clinical evaluation and multimodal imaging are essential for timely management. Despite a generally poor prognosis, novel therapeutic modalities appear promising in improving both quality of life and life expectancy in cancer patients. Continued collaborative research and a multidisciplinary management strategy between ocular oncologists, radiation oncologists, and medical oncologists will lead to a better understanding of tumor biology and optimize patient outcomes.