Simultaneous eyelid and choroidal metastases 36 years after diagnosis of medullary thyroid carcinoma

A 56-year-old man had a 6-month history of a progressively enlarging mass of his right upper eyelid. Thirty-six years previously he had undergone thyroidectomy for medullary thyroid carcinoma in the absence of family history. Supraclavicular lymph node metastases were discovered 3 years after initial diagnosis, pulmonary metastasis 26 years later, and cervical lymph node metastases 35 years later. Ocular examination revealed a pedunculated, amelanotic, highly vascularized metastasis involving the right upper eyelid and palpebral conjunctiva. Ophthalmoscopy revealed 2 amelanotic, dome-shaped choroidal metastases in the right eye and 3 similar tumors in the left eye. Medullary thyroid carcinoma not associated with the multiple endocrine neoplasia syndromes can metastasize to the ocular region and metastases can occur decades after the original diagnosis.