eighty - eight percent of the metastatic foci are detected in the choroid , 9% in the iris and 2% in the ciliary body . typical choroidal metastases are plateau - shaped , cream - colored and occur with subretinal fluid and retinal detachment . metastatic choroidal lesions are mostly seen in the posterior pole where blood flow is the highest . the most common cause of orbital metastases in women is breast cancer , and in men , it is lung cancer . treatment of these tumors , which may cause a drastic decrease in sharpness of sight , consists of laser photocoagulation , cryotherapy , chemotherapy , radiotherapy ( rt ) , surgical resection and photodynamic therapy . in small tumors not hindering the sight , treatment response can be achieved with systemic therapy . in symptomatic large lesions , external rt we report a case of lung cancer presenting first with symptoms caused by orbital metastases . in the orbital examination , a 67-year - old male patient coming to the ophthalmologist with complaints of blurry vision showed subretinal fluid and choroidal folding , and these findings were considered as metastatic lesions . the chest x - ray ordered due to the patient 's complaints of persistent cough for a couple of months showed a right hilar mass . on thorax computed tomography ( ct ) , multiple nodular lesions in bilateral lungs and left pleural effusion was detected ( fig 1 ) , and a transbronchial bronchoscopic biopsy of the lower posterior lobe of the left lung was determined as primary lung adenocarcinoma . positron emission tomography ( pet)-ct showed a primary involvement in the medial segment of the left lung and widespread hypermetabolic nodules in bilateral lungs , metastatic mediastinal lymphadenopathies and widespread skeletal metastases , the majority in the vertebral column , pelvic bones and in the proximal part of the bilateral femurs . no mass lesions were seen in brain magnetic resonance imaging ( mri ) . on repeat fundus examination , yellow - white choroidal swelling with irregular borders in the right eye ( fig 2 ) , yellow choroidal lesions and serous retinal detachment in left eye ( fig 3 ) was observed . in optical coherence tomography ( oct ) images , retinal swelling and choroidal irregularities were noticed ( fig 4 ) . orbital mri showed plaques of a maximum thickness of 2 mm with pathologic contrast enhancement in posterolateral regions of the bilateral globes . a first palliation of 30 gy was given to lumbar 4 vertebrae , pelvic bones and the proximal half of the right femur in 12 fractions . the second palliation site was thoracic 512th vertebrae treated with 30 gy in 10 fractions . external rt to orbitae was started next , with the radiation field excluding the neural parenchyma ( fig 5 ) . after the third fraction of orbital rt , the patient demonstrated involuntary muscle movements , nonsensical speech and impaired balance . even though not proven radiologically , these findings were evaluated as likely cranial metastases clinically , and the rt plan was revised to cover the cranium and bilateral orbitae to the palliative dose of 30 gy with 3d conformal rt . during the follow - up period , the performance status of the patient advanced to ecog performance status 3 , and approximately 4 months after the diagnosis , the patient died because of disease progression . presentation with blurry vision due to choroidal metastases as initial finding in lung cancer is highly uncommon . upon detection of choroidal lesions in the fundoscopic examination isolated orbital metastases and treatment of these cases with laser ablation and rt have been reported . in widespread choroidal metastases where laser ablation is inadequate , rt to the orbitae is a treatment option . with 3d conformal rt or intensity - modulated rt , bilateral sparing of lenses is possible while the posterior globe is irradiated sufficiently within normal tissue tolerances . in this case , even though radiologically isolated bilateral orbital metastases were found , rapidly declining performance and development of neurological symptoms of the patient pointed to microscopic cranial metastasis , and palliative rt to bilateral orbitae and to the cranium was given . systemic chemotherapy could not be started because of declining performance and the patient died due to disease progression . of the patients presenting with a decrease in sight and detected to have choroidal metastases , 47% are reported to have breast cancer and 21% lung cancer . this incidence was reported as 7.1% in a series of 87 lung cancer cases by kreusel et al . . despite the fact that there are efficient treatment options for orbital metastases , the benefit of procedures to detect choroidal metastases is debatable due to the quick progression and poor prognosis of lung cancer . in concordance , orbital metastases can be an initial finding or detected after the diagnosis of lung cancer . in case of choroidal metastases resulting from lung cancer , patients usually present with decreased sight . defects in the field of vision , flashes of light and floating bodies generally follow . these secondary symptoms are the result of retinal detachment occurring on or around the lesion . lesions are usually yellow - cream - colored [ 4 , 7 ] . to determine the nature and spread of the lesions , various methods including fundus fluorescein angiography , ultrasonography , oct , ct , mri or fine - needle aspiration biopsy are employed . similarly , subretinal fluid and choroidal folding was found in our case . on repeat fundoscopic examination , yellow - white choroidal swelling with irregular borders in the right eye and yellow choroidal lesions and serous retinal detachment in the left eye was observed , and the nature and spread of these lesions were assessed with oct . treatment options of choroidal metastases include many methods including laser photocoagulation , cryotherapy , chemotherapy , rt , surgical resection , enucleation and photodynamic therapy . there are reports emphasizing rt as the most efficient treatment option . in a series of 233 orbital metastases by rudoler et al . , 57% treated with rt have gained an increase in vision , while 93% of the patients achieved significant regression of the tumor size or no progression at all . there are also studies reporting chemotherapy as one of the treatment options . in solitary and small lesions , or in lesions not responding to rt or chemotherapy , laser photocoagulation or photodynamic therapy should be considered . in our case , afterwards , palliative rt to bilateral orbitae was started . in conclusion , while choroidal metastases are a sign of poor prognosis , treatment options should be revised to achieve improvement in visual functions and quality of life . each patient should be assessed according to his / her respective performance status , stage of the disease , state of present metastatic lesions , tumor type and size in order to choose the appropriate treatment option .
the most common malignancy of the eye is metastatic tumors , with choroidal metastases being the majority of them . in women , 
 breast cancer is the most common cause of orbital metastases , and in men , it is lung cancer . despite the fact that there are efficient treatment options for orbital metastases , the benefit of procedures to detect choroidal metastases is debatable due to the quick progression and poor prognosis of lung cancer . in choroidal metastases resulting from lung cancer , 
 patients are usually presented with decreased sight . 
 defects in the field of vision , flashes of light and floating bodies generally follow . 
 treatment options of choroidal metastases include many methods including laser photocoagulation , cryotherapy , chemotherapy , radiotherapy , surgical resection , enucleation and photodynamic therapy . 
 there are reports emphasizing radiotherapy as the most efficient treatment option . in this case report , we sum up the case of a male patient presenting with blurry vision in both eyes , who was subsequently detected to have bilateral choroidal metastatic tumor and was diagnosed with primary lung adenocarcinoma .