Eye tumor presenting with altered vision
Case History
Patient is a 50 year old woman who for 3 months has noticed an intermittent "halo" in her temporal field of vision. She denies flashes, floater, or change in central vision.
Past medical history:
High blood pressure
Past ocular history:
Myopia
Exam:
Vision: 20/20 each eye
Pupils: normal responses each eye
| Anterior segment exam: |
No evidence of cataract
No evidence of glaucoma
Trace cell in the anterior vitreous of the right eye |
Fundus exam:
Right eye:
There is a large, non-pigmented, smoothly domed lesion arising from the choroid in the superotemporal quadrant. There is no detachment of the retina. The optic nerve, vessels and macula are normal.
Left eye:
Normal fundus
Fluorescein angiogram: (right eye)
Early Angiographic Image |
Late Angiographic Image |
There is a hyperfluorescence early, which becomes progressive in mid phases,
and widespread by the end of the angiogram.
B-scan ultrasonography: (right eye)
There is an acoustically hollow lesion in the superotemporal quadrant. It is 6.0mm in height and the base is 11mm. The lesion arises from the subretinal space.
Diagnosis:
Choroidal Melanoma right eye
Differential diagnosis: (unlikely) leiomyoma, schwanoma or metastasis
Comment:
Choroidal melanoma is a malignant tumor which occurs in 6 out of one million people per year. Excluding metastasis, it is the most common tumor of the eye. Choroidal melanomas can occur at any age, but most are seen in individuals in their 50's and 60's.
Most melanomas are smoothly domed or mushroom shaped. The majority (around 80%) are pigmented. An exudative retinal detachment may also occur. This case is not pigmented, and not associated with a retinal detachment.
Treatment options for Choroidal melanoma include radiation, local resection, laser or thermal therapy, and enucleation (removal of the eye). If metastasis are present chemotherapy is used. If a tumor is small, it can be observed carefully.
Most individuals diagnosed with melanoma do not have distant spread, and undergo local treatment. The eye is usually retained, but vision may be affected. If local treatment fails, enucleation or removal of the eye is typically the next treatment recommended. In some patients metastasis may occur, requiring systemic chemotherapy.
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