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Malignant melanoma of the ciliary body
Clinical Eye and Vision Care 7 (1995) 57-58
Letter to the editor
Malignant melanoma of the ciliary body Peter G. Swann, Glen A. Horgan School
of Optometry,
Queensland
Unioersity
of Technology,
Brisbane,
Australia
1. Introduction
2. Case report
We were interested to read the brief but thorough review of aspects of intraocular melanoma that was recentIy published in Clinical Eye and Viion Care [ll. The authors reported a case of ciliary body melanoma and we have seen a similar case which had a most interesting presentation.
WF, a 27-year-old white male, presented to one of us in private practice (GAH) because glare from sunlight was becoming intolerable. This was not surprising as he was a person of very fair complexion. It was his first eye examination. The remainder of the case history was unremarkable. General health was
0953~4431/95/$09.50 0 1995 Elsevier Science Ireland Ltd. All rights reserved. SSDZ 0953-4431(95)00108-F
58
P.G.
Swam,
GA.
Horgnn
/Clinical
Eye and Vision
good and there was no history of eye disease in blood relatives. Unaided vision was R 20/30 L 20/120 and this corrected to R20/15 L 20/20-3 with R -0.50 sph L -1.25/1.75 x 105. He was unaware of the poor vision in his left eye! Intraocular pressure with the NCT was R 10 L 14 mmHg. Biomicroscopy revealed a light brown lesion in the left iris root at nine o’clock with an adjacent iris transillumination defect (Fig. 1). Blood vessels were apparent on the surface of the lesion. A dilated episcleral vessel was not matched by a similar vessel in the other eye and some cyst-like changes were present in the bulbar conjunctiva at the nasal limbus. A slit beam showed the lesion to be in virtual apposition to the cornea1 endothelium (Fig. 2). The fundi were normal. The patient was immediately referred to an ophthalmologist who sent him for photography to one of the authors (PGS). At this examination, two weeks after the initial consultation, best corrected vision in the left eye had declined to 20/120 with Piano/ - 4.75 x 75. The left retinostopic reflex was scissored and keratometry revealed undistorted mires and a small degree of with-the-rule astigmatism in each cornea. Even though the pupil dilated poorly adjacent to the lesion, the main body of the melanoma could easily be seen (Fig. 3). A general medical workup revealed no metastases and the tumor was removed via an iridocyclectomy (Fig. 4). Histologically, the melanoma had a spindle B cell type. Three years later, the patient remains well but has 20/120 vision in the left eye due to a cataract
Care 7 (1995)
57-58
that has developed subsequent to the surgery. A tinted soft contact lens that was prescribed after surgery has been discarded in favor of sunglasses. 3. Comment Ciliary body melanomas are difficult to diagnose, especially in their early stages as they are effectively hidden from observation by the iris. Therefore, optometrists must be aware of changes which these tumors may cause in neighboring structures. These include dilated episcleral vessels, iris elevation, sectoral cataract formation, inflammatory signs in the anterior chamber, raised intraocular pressure or nonrhegmatogenous retinal detachment [2]. The ciliary body tumor may also impinge against the lens, causing a rapidly increasing, irregular, lenticular astigmatism and resultant decreased visual acuity. The patient may be unaware of their vision loss as in the case described here. As Halverson et al. [l] point out, there is a significant mortality from intraocular melanomas, and therefore it is vital that they are detected at the earliest possible stage. References [I]
Halverson KD, Ruder At, Jones WL, Austin JK. Intraocular melanoma. Clin Eye Vision Care 1994;6:146-149. [2] Kanski JJ. Clinical Ophthalmology. London: Butterworths, 1984:14.2-14.3.
Fig. 1. (Top left) Ciliary body melanoma inculcating the iris at nine o’clock. Surface blood vessels are present. A dilated episcleral vessel and cystic changes at the limbus are apparent. Fig. 2. (Top right) The tumor almost touching the cornea1 endothelium. Fig. 3. (Bottom left) The main body of the tumor can be seen through a dilated pupil. The nasal iris has dilated poorly. Fig. 4. (Bottom right) Surgical removal by an iridocyclectomy.
Letter to the editor
Malignant melanoma of the ciliary body Peter G. Swann, Glen A. Horgan School
of Optometry,
Queensland
Unioersity
of Technology,
Brisbane,
Australia
1. Introduction
2. Case report
We were interested to read the brief but thorough review of aspects of intraocular melanoma that was recentIy published in Clinical Eye and Viion Care [ll. The authors reported a case of ciliary body melanoma and we have seen a similar case which had a most interesting presentation.
WF, a 27-year-old white male, presented to one of us in private practice (GAH) because glare from sunlight was becoming intolerable. This was not surprising as he was a person of very fair complexion. It was his first eye examination. The remainder of the case history was unremarkable. General health was
0953~4431/95/$09.50 0 1995 Elsevier Science Ireland Ltd. All rights reserved. SSDZ 0953-4431(95)00108-F
58
P.G.
Swam,
GA.
Horgnn
/Clinical
Eye and Vision
good and there was no history of eye disease in blood relatives. Unaided vision was R 20/30 L 20/120 and this corrected to R20/15 L 20/20-3 with R -0.50 sph L -1.25/1.75 x 105. He was unaware of the poor vision in his left eye! Intraocular pressure with the NCT was R 10 L 14 mmHg. Biomicroscopy revealed a light brown lesion in the left iris root at nine o’clock with an adjacent iris transillumination defect (Fig. 1). Blood vessels were apparent on the surface of the lesion. A dilated episcleral vessel was not matched by a similar vessel in the other eye and some cyst-like changes were present in the bulbar conjunctiva at the nasal limbus. A slit beam showed the lesion to be in virtual apposition to the cornea1 endothelium (Fig. 2). The fundi were normal. The patient was immediately referred to an ophthalmologist who sent him for photography to one of the authors (PGS). At this examination, two weeks after the initial consultation, best corrected vision in the left eye had declined to 20/120 with Piano/ - 4.75 x 75. The left retinostopic reflex was scissored and keratometry revealed undistorted mires and a small degree of with-the-rule astigmatism in each cornea. Even though the pupil dilated poorly adjacent to the lesion, the main body of the melanoma could easily be seen (Fig. 3). A general medical workup revealed no metastases and the tumor was removed via an iridocyclectomy (Fig. 4). Histologically, the melanoma had a spindle B cell type. Three years later, the patient remains well but has 20/120 vision in the left eye due to a cataract
Care 7 (1995)
57-58
that has developed subsequent to the surgery. A tinted soft contact lens that was prescribed after surgery has been discarded in favor of sunglasses. 3. Comment Ciliary body melanomas are difficult to diagnose, especially in their early stages as they are effectively hidden from observation by the iris. Therefore, optometrists must be aware of changes which these tumors may cause in neighboring structures. These include dilated episcleral vessels, iris elevation, sectoral cataract formation, inflammatory signs in the anterior chamber, raised intraocular pressure or nonrhegmatogenous retinal detachment [2]. The ciliary body tumor may also impinge against the lens, causing a rapidly increasing, irregular, lenticular astigmatism and resultant decreased visual acuity. The patient may be unaware of their vision loss as in the case described here. As Halverson et al. [l] point out, there is a significant mortality from intraocular melanomas, and therefore it is vital that they are detected at the earliest possible stage. References [I]
Halverson KD, Ruder At, Jones WL, Austin JK. Intraocular melanoma. Clin Eye Vision Care 1994;6:146-149. [2] Kanski JJ. Clinical Ophthalmology. London: Butterworths, 1984:14.2-14.3.
Fig. 1. (Top left) Ciliary body melanoma inculcating the iris at nine o’clock. Surface blood vessels are present. A dilated episcleral vessel and cystic changes at the limbus are apparent. Fig. 2. (Top right) The tumor almost touching the cornea1 endothelium. Fig. 3. (Bottom left) The main body of the tumor can be seen through a dilated pupil. The nasal iris has dilated poorly. Fig. 4. (Bottom right) Surgical removal by an iridocyclectomy.