First Author: A.Arora UK
Co Author(s): K. Hammamji E. Reich E. Pavlidou K. Kopsidas V. Cohen M. Sagoo 0 0 0 0 0 0 0 0 0
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To highlight that an intraocular tumour may mimic neurological disorders
Dept of Ocular Oncology, London
A 41-year-old white male with a known history of multiple sclerosis and right optic neuritis presented with a 6-month history of decreased vision in the same eye, with occasional photopsiae. He was evaluated by a neurologist, who treated with two courses of oral steroids for presumed recurrent optic neuritis. After a slight temporary improvement, his vision worsened, following which a head MRI revealed a solid intra-ocular mass and was referred to our department. On examination, his visual acuity was 6/24 in the right eye and 6/6 in the left eye. Anterior segment examination, intraocular pressures and dilated left fundoscopy were normal. The right fundus showed a pigmented, elevated lesion temporal to the fovea. There was local sub-retinal fluid and an inferior exudative retinal detachment, as well as lipofuscin on the lesion. B scan ultrasound showed a dome shaped lesion with low internal reflectivity, in which the elevation was 5.7mm and the base 12.5mm.
Although rare, choroidal melanoma is the most common primary intraocular malignant tumour in adults (incidence 6 cases per million population). Symptoms include blurred vision and photopsiae, depending on the size and location of the tumour, but can be asymptomatic.Diagnosis of choroidal melanomas is usually clinical, with fundoscopy and ancillary tests including B-scan ultrasonography and in some cases fluorescein angiography. Management options include charged particle irradiation, plaque brachytherapy, local resection, enucleation, laser treatment or rarely observation. Choice of treatment depends on multiple factors including tumor size, visual acuity of the affected eye and contralateral eye, age and general health of the patient, and the presence of metastases. Choroidal melanoma can masquerade other entities, such as intraocular hemorrhage, inflammatory granulomas, scleritis and others. In this case, there was an assumption that the visual symptoms were related to previous neurological diagnosis, particularly as undilated fundoscopy can be challenging.