Neovascular Glaucoma Secondary to Choroidal Metastasis From Lung Adenocarcinoma: A Palliative Management Challenge

Choroidal metastasis is the most common intraocular malignancy in adults and may present as the initial manifestation of an underlying systemic malignancy. We report a case of a 62-year-old woman who presented with unilateral progressive visual deterioration and was initially referred with a working diagnosis of ocular tuberculosis (TB). Ocular examination revealed a non-pigmented choroidal mass with exudative retinal detachment. Subsequent imaging identified a lung lesion, and a primary lung malignancy was suspected based on contrast-enhanced computed tomography of the thorax. Histopathological examination later confirmed lung adenocarcinoma. The choroidal metastasis demonstrated rapid progression, with anterior extension leading to shallowing of the anterior chamber, rubeosis iridis, and eventual development of neovascular glaucoma (NVG) with acute angle closure. The patient developed severe ocular pain with markedly elevated intraocular pressure, which was refractory to maximal medical therapy. Management was guided by the advanced stage of systemic disease and poor visual prognosis. As enucleation was declined by the patient, palliative external beam radiotherapy was performed, resulting in significant symptomatic relief. This case underscores the importance of early consideration of malignancy in atypical choroidal lesions, particularly in TB-endemic settings, and highlights the potential for rapid intraocular progression with significant complications. A multidisciplinary, patient-centred approach with emphasis on symptom palliation is essential in advanced disease.