title: Unrelenting Ocular Pain as a Masquerading Symptom of Occult Choroidal Metastasis.
abstract: OBJECTIVE
  To report a case of chronic eye pain as a presenting feature of choroidal metastasis from lung cancer.
  
  
  METHODS
  We report the case of a 58-year-old Caucasian woman with stage IV lung adenocarcinoma presenting with an 8-month history of left eye pain and blurred vision.
  
  
  RESULTS
  The patient had previously consulted 14 ophthalmologists with varying diagnoses including posterior scleritis and trigeminal neuralgia. Visual acuity at presentation was 20/20 in the right eye and 20/80 in the left eye. Examination of the right eye was normal, while the left eye showed ill-defined flat yellow discoloration of the choroid with overlying shifting subretinal fluid. Ultrasonography demonstrated a dense choroidal thickening measuring 2.6 mm in size and showing subretinal fluid. Enhanced depth imaging optical coherence tomography revealed choroidal thickening with a 'lumpy bumpy' surface topography consistent with a metastatic choroidal tumor presumably from the patient's lung adenocarcinoma. Fine needle aspiration biopsy followed by treatment was recommended, but the patient declined and later succumbed to metastatic disease.
  
  
  CONCLUSIONS
  We present a case of chronic eye pain associated with diffuse choroidal thickening from metastatic lung adenocarcinoma that was previously unrecognized and misdiagnosed. This case emphasizes the importance of recognizing pain as a presenting symptom of choroidal metastasis.
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa., USA.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Deaner
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa., USA.
authors.forename: Renelle
authors.initials: R
authors.lastname: Pointdujour-Lim
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa., USA.
authors.forename: Emil Anthony T
authors.initials: EA
authors.lastname: Say
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa., USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
keywords: Choroidal metastasis; Lung carcinoma; Ocular pain; Scleritis