West Indian Med J 2009; 58 (3): 283 A 61 year-old male coffee farmer presented with a history of gradual loss of vision of two years duration in his right eye. He also had a one-week history of swelling and tenderness of the right eye and gradual, painless visual loss in the left eye. There was a six-month history of intermittent fever, nausea, night sweats, anorexia, weight loss and constipation. He did not smoke nor had any chest complaints. He had no light perception and saw no hand move- ments in the right and left eyes respectively. The right eye had upper lid oedema, proptosis and an external ophthalmo- plegia. He had a shallow anterior chamber with inflam- matory cells, a mid-dilated unreactive pupil, nuclear sclerosis and a dense vitritis which obscured the fundal view. Examination of his left eye revealed nuclear sclerosis, vitritis and multiple choroidal lesions with overlying ‘bone- spicule’ like hyperpigmentation of the inferior retina asso- ciated with an exudative retinal detachment. Intraocular pressures were 34 mmHg (right eye) and 11 mmHg (left eye). B-scan ultrasonography of the right eye revealed dense vitri- tis and multiple areas of choroidal thickening (Fig. 1). He was assessed as a right orbital cellulitis, glaucoma and bila- teral uveitis (masquerade syndrome). He was commenced on systemic and topical antibiotics and anti-glaucoma therapy with improvement of the cellulitis and glaucoma; however, his vision remained unchanged. His haemoglobin was 14.7 g/dL, WBC 6.7 X 10 9 /L and ESR 20 mm/hr (Westergren). Vitreous biopsy of the left eye revealed a few atypical mature lymphocytes. The magnetic resonance imaging (MRI) of the brain and orbits revealed areas of choroidal thickening in both eyes (Fig. 2). Computed Tomo- CASE REPORTS An Unusual Case of Bilateral Visual Loss from Metastatic Lung Cancer L Mowatt, J Grant From: Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica, West Indies. Correspondence: Dr L Mowatt, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica, West Indies. Fax: (876) 702-4432, e-mail: lizette mowatt@yahoo.com. Fig. 2: T1 weighted MRI of orbits with contrast showing the bilateral involvement of vitreous and choroidal thickening from the lung metastases. Fig. 1: B-scan ultrasound of the right eye revealed vitreous opacities and areas of choroidal thickening in the posterior pole. graphy (CT) and MRI of the chest revealed a soft tissue mass (3.1 cm x 2.2 cm) in the lower lobe of the left lung. Magnetic resonance imaging of the abdomen showed multiple foci of lesions in the liver and adrenal, cholelithiasis and a thrombus in the inferior vena cava. This patient refused chemotherapy and defaulted from follow-up. Intraocular metastases are the most common malignant ocular tumours with a predilection for the uveal tissue (1). The most common primary includes the breast in females and bronchi in males (1). There is a 7.1% incidence of choroidal metastasis in pulmonary carcinoma, usually occurring after at least two other organs (p = 0.3) have been involved in the metastasis (2). Ocular metastasis may precede the detection of the primary carcinoma in 36–58% by as long as 13 months (2, 3). Shields et al noted that 34% of patients with choroidal metastases had no prior history of cancer (4).