Case 1 - Click here for Text and References

Submitted by: Charleen Chu

Clinical Summary:

The patient is a 55 year old Caucasian man who presented with “loss of vision” in the left eye. His past medical history includes hepatitis C since 2000, post-traumatic stress disorder, ganglion cyst removed from the right foot, midline hernia operation, appendectomy and tonsillectomy. On July 4, he had checked into a VA hospital to “change his medications.” On July 10, he noticed visual changes consisting of lights and spots of color described as “fireworks.” A left choroid tumor with overlying retinal detachment extending into the macular region was diagnosed. Ultrasound was consistent with melanoma of the choroid. The patient then left the hospital against medical advice due to concern about this new diagnosis. Six days later, he was encouraged by his wife to return, entering the drug rehabilitation program for marijuana abuse. The patient then developed a throbbing pain that starts behind the left eye, radiating to the back of the neck and sometimes causing headache. The pain is responsive to ibuprofen. Occupational history includes construction and coal mining (for 10 months) and military service in Vietnam. The patient smokes 1.5 packs/day and uses marijuana once very 3 weeks. There is a remote history of i.v. heroin, cocaine and PCP usage. ROS: The patient denies fever, chills, nausea, vomiting, chest pain, shortness of breath, cough, history of TB or weight change. He has daily headaches for the past 9 months.

Pertinent Laboratory Data:

Physical exam: Pleasant, well-appearing, thin white male, fully oriented. VITALS: T 97.5 HR 75 RR 16 BP 131/84 sat 98% RA Vision is 20/40 OD; No light perception OS. Intraocular pressure is 12 OD and 16 OS. Anterior chambers are quiet. Corneas are clear. There is slight conjunctival injection on the left eye. On dilated fundus examination, the right eye retina shows a healthy-appearing disc, macular vasculature and periphery. On the left eye, there is a total retinal detachment with an underlying mass. The rest of exam reveals mild hepatosplenomegaly, an enlarged prostate, and a small, tender mass on the right foot.

Case 2 - Click here for Text and References

Submitted by: Lynn Schoenfield

Clinical Summary:

The patient was a 30 year old woman who presented with a 2 week history of left upper eyelid swelling and discomfort with upward gaze. Her past medical history was significant for severe adult-onset asthma that was controlled with oral corticosteroids, the dose of which had been recently tapered. She was also diagnosed with rheumatoid arthritis a year prior to her presentation at another institution for which she was started on plaquenil treatment with improvement in her constitutional symptoms and joint pain. Ocular exam revealed a well demarcated superonasal nodule involving the conjunctiva, with no other abnormalities noted.

Pertinent Laboratory Data:

A CT scan revealed increased soft tissue adjacent to the superonasal aspect of the left globe with mild prominence of the left superior rectus and levator palpebrae muscles.

Case 3 - Click here for Text and References

Submitted by: Neena M. Mirani

Clinical Summary:

A 39-year-old HIV-positive Guatemalan man had decreased vision, epiphora, and pain in the right eye for 18 months. He had been continuously maintained on highly active antiretroviral therapy for 2 years. He also gave history of 24 lbs weight loss in 6months, occasional postprandial vomiting for 3 months. No fever, sweating, or flu-like symptoms. In right eye there was a conjunctival mass, with a yellowish gelatinous temporal lesion extending from 9- o'clock position to 12-o'clock position with associated symblepharon and feeder vessels. CT with contrast revealed Enhancement and prominence of right eye lid and enlarged lacrimal gland. Excisional biopsy of the conjunctival mass was performed.

Pertinent Laboratory Data:

HIV viral load of less than 48 copies/mL and CD4 lymphocyte count of 79 cells/µL.

Case 4 - Click here for Text and References

Submitted by: Alexandre N. Odashiro

Clinical Summary:

Fifty-year old man with an iris lesion in the right eye. The lesion was light brownish and somewhat elevated. Patient has been seeing by the ophthalmologist for 6 months. The lesion had no change in colour, but showed a slightly growth. No other lesion was seen in the ophthalmic region. The clinical differential diagnosis included melanoma, nevus, leiomyoma, others. An excision biopsy was performed.

Case 5 - Click here for Text and References

Submitted by: Charles Eberhart

Clinical Summary:

This 56 year old female patient had been followed for several decades with intraocular lesions originally arising in the retina, which eventually led to complete loss of vision in both eyes. Over the months prior to her enucleation procedure, there had been a lesion evident on the upper surface of the left eye. On clinical examination, she had a large, vascularized epibulbar mass involving the superior aspect of the left globe.