[Metastatic neoplasia in the optic nerve]

Ocular metastasis always involves the uveal tractus, especially the choroid. Papillary metastases have been exceptionally described, and represent only 5 percent of the ocular metastatic locations. We report in this observation a case of papillary metastasis in a patient treated for a metastatic adenocarcinoma.

A 35-year-old woman was given chemotherapy for four months for metastatic adenocarcinoma involving the pleura and bones. She consulted for significant decline of visual acuity in the left eye associated with headache and vomiting. The fundus examination revealed a yellowish papillary lesion with edema associated with an inferior peripapillary serous retinal detachment. The fluorescein retinal angiography showed a choroidal lesion highly suggestive of choroidal metastasis. Cerebro-orbital CT scan revealed the presence of multiple cerebral metastases. The patient died four months after diagnosis of ocular metastasis and eleven months after diagnosis of adenocarcinoma.

Presence of a papillary lesion suggests the possible diagnosis of papillary metastasis despite the lack of a history of neoplasia. Carcinomatosis tumors, especially breast and the lung carcinomas are the most frequent causes of papillary metastasis.