What happened, in summary

A 60-year-old man developed five days of pain and redness in his right eye. Examination showed inflammation, new blood-vessel growth around the pupil, elevated eye pressure, and a vascular gray-white mass on the iris. The lesion measured about 4 by 2 by 1 mm and extended toward the drainage angle of the eye. Initial possibilities included inflammatory granuloma, an amelanotic melanoma, or an iris cyst. Tests for tuberculosis and sarcoidosis were negative.

Systemic imaging had identified a primary lung cancer. Because the iris lesion arose from the anterior surface and the patient had a known malignancy, clinicians suspected metastatic disease. They performed a punch biopsy of the iris mass and administered intravitreal bevacizumab during the same procedure. Pathology confirmed iris metastasis from non-keratinising squamous cell carcinoma of the lung in the setting of multiple metastatic disease. He was referred to medical oncology to consider palliative systemic chemotherapy.

One month after bevacizumab, the iris mass had decreased to about 2 by 1 mm and showed less vascularity. Eye pressure fell from 22 to 16 mm Hg, pain and redness improved, and visual acuity increased from 20/40 to 20/30. Longer follow-up was not possible because he later died from systemic complications of the cancer. The local response relieved eye symptoms but did not alter the overall course of widespread metastatic lung disease.