Erlotinib as a Successful Treatment of Vision-Threatening Ocular Metastases from Non-Small-Cell Lung Cancer

A 54 year old healthy man presented with a two-month history of decreased vision of the right eye (OD). His past medical history was unremarkable, with no history of smoking. Vision was 1/60 for OD and 1.0 for the left eye (OS). The right eye showed a large, solid choroidal mass with exudative retinal detachment and was clinically suspected for a choroidal metastasis. CT imaging revealed pulmonary and osseous lesions. Biopsies showed TTF1-positive adenocarcinoma with an EGFR mutation. Treatment with erlotinib was started. After one month visual acuity increased to 0.32, with further improvement to 0.9 after three months. Five months after erlotinib was started, bone metastases progressed without deterioration of vision and our patient died ten months after onset of treatment. Choroidal metastases can be a presenting manifestation of lung carcinoma and erlotinib can cause rapid and lasting recovery of vision in the palliative phase.