Choroidal metastasis from lung adenocarcinoma
D. Rule out an occult systemic neoplasm
Choroidal effusion consists of serous-hemorrhagic fluid accumulation in the suprachoroidal space typically encountered in trauma, surgery, or uveitis scenarios.1,2 It can produce a mass effect simulating tumors2 or be the presenting feature of ocular neoplasms,3 requiring elucidation as to its origin and nature. In this patient, disproportional choroidal exudation in the context of a solid lesion unresponsive to steroid therapy was strongly suggestive of malignancy.
The yellow discoloration noted in only 1 eye was unusual and likely reflected a subacute process related to long-standing choroidal fluid buildup.4 Unlike the scleral impregnation with bilateral involvement classically seen in jaundice,5 the ocular coloration changes developed in this patient indicated a local mechanism, mediated by fluid extravasation from the choroidal compartment to the subconjunctival space.4 Therefore, screening for causes of bilirubin elevation, such as liver dysfunction and biliary tract obstruction (choice A), would not be the first step taken.