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Cancers affecting the retina usually begin in the choroid. Because the retina depends on the choroid for its support and half of its blood supply, damage to the choroid by a cancer is likely to affect vision.
Choroidal melanoma:
Choroidal melanoma originates in the choroidal melanocytes. Choroidal melanoma is the most common cancer originating in the eye, with an incidence of about 1 in 2500 whites. It is less common among darker-skinned people. It occurs most frequently at age 55 to 60. It may spread locally or metastasize and be fatal.
Symptoms tend to develop late and include loss of vision and symptoms of retinal detachment (see Retinal Disorders: Retinal Detachment).
Diagnosis is by funduscopy, supplemented, when indicated, by other tests, such as ultrasonography, CT, fluorescein angiography, and serial photographs.
Small cancers are treated with laser, radiation, or radioactive implants, which may preserve vision and save the eye. Rarely, local resection is used. Large cancers require enucleation.
Choroidal metastases:
Choroidal metastases are common because the choroid is highly vascular. The most common primary cancers are those of the breast in women and of the lung and prostate in men.
Symptoms tend to develop late and include loss of vision and symptoms of retinal detachment.
Diagnosis is often incidental during routine ophthalmoscopy. Ultrasonography is usually done, and the diagnosis is confirmed using fine-needle biopsy.
Treatment is usually with chemotherapy, radiation therapy, or both.
Last full review/revision December 2008 by Sunir J. Garg, MD, FACS
Content last modified December 2008
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