CRA31 THE EYE NEVER LIES: WHEN A LESION UNVEILS LUNG CANCER

S. Darshini¹, Nor Safiqah Sharil^1,2, Nik Nuratiqah Nik Abeed¹, Boon Hau Ng¹, Xin Yee Chong³, Rose Azzlinda Osman¹, Andrea Yu-Lin Ban¹

1.      Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
2.      Internal Medical Unit, Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan.
3.      Ophthalmology Department, Hospital Cyberjaya, Selangor

Background
Ocular manifestations as the first sign of systemic malignancy are rare and pose a diagnostic challenge. While choroidal metastasis is more common, iris involvement is infrequent and may go unrecognized. Lung adenocarcinoma, particularly non-small cell subtypes, has been identified as a frequent source of ocular metastases. Notably, iris metastasis may precede systemic symptoms and are associated with poor prognosis.

Case Report
We report the case of a 70-year-old man with no prior medical history who was referred to the respiratory clinic following ophthalmologic findings. He initially presented himself with one month of left eye redness and progressive blurred vision. Initial assessment showed a red eye and reduced visual acuity (6/20) without detectable lesions. He was treated with topical dexamethasone and reviewed six weeks later, when he reported worsening vision. Examination revealed a hypopigmented iris mass measuring 7 mm × 5.7 mm, and his visual acuity had declined to 6/60.

The patient was diagnosed with left eye amelanotic iris melanoma, prompting further systemic investigation. A chest X-ray revealed a large left lung mass, and biopsy confirmed lung adenocarcinoma. He was empirically started on gefitinib, an EGFR tyrosine kinase inhibitor, while awaiting molecular profiling.

Conclusion
This case highlights the importance of considering metastatic disease in atypical ophthalmic presentations, especially in older patients with new-onset ocular symptoms. Prompt interdisciplinary collaboration can expedite diagnosis of underlying malignancy and improve outcomes.