intraocular tumours

Question 1

Name the uveal melanomas

Answer 1

• Malignant melanoma - choroid
• Malignant melanoma - CB
• Malignant melanoma - iris

Question 2

Discuss the features of a choroidal naevus

Answer 2

• benign melanoma
• size: 1-2DD, most <5mm, <1mm thick (larger = malignant), stationary in size
• mx: observe, monitor, review 1-2 yrs

Question 3

Signs and symptoms of choroidal malignant melanoma

Answer 3

• No symptoms if small, if larger - metamorphopsia, photopsia, VF loss
• Signs: pigmented lesion (orange tinge, varied colour), irregular, patchy, round, Serous detachment at margins (retinal folds), vascularisation (choroidal BV), haemorrhage, CMO common, vitreous haem, cataract, anterior uveitis (due to tumour necrosis), increase IOP (large –> spread to anterior chamber angle)

Question 4

Features of choroidal malignant melanoma

Answer 4

• enlargement restricted: sclera and choroid
• Penetration through BM: “collar button” effect
• ## Penetration through sclera: extension into orbit

Question 5

Diagnosis of choroidal naevus vs. melanom

Answer 5

TFSOM 
- Thickness (>2mm) 
- Subretinal fluid 
- Symptoms (reduced VA) 
- Orange pigment 
- Melanoma hollow
- Diameter (>5mm)
==> 5 year estimate of progression 
1% (no risk factor), 11% (1 risk factor), 22% (2 factors), 34% (3 risk factors), 51% (4 risk factors), 55% (5 factors)

Question 6

Managing choroidal malignant melanoma

Answer 6

• Refer
  Fl angio (vascularisation)
• plaque irradiation (can lead to radiation retinopathy), laser photocoagulation, transpupillary thermography, local resection (enter via sclera, remove tumour), enucleation

Question 7

Features of CB malignant melanoma

Answer 7

• blurred vision or no symptoms
• lens anomalies (odd astig, cataract, subluxation)
• dilated episcleral vessels
• sub-conj pigment
• IOP (decrease: less aqu pigment, increase: extension into angle, outflow obstruction)
• Anterior uveitis (necrosis)
  Mx: refer. Local resectioning (iridocyclectomy), enucleation

Question 8

Features of iris malignant melanoma

Answer 8

• ‘Brown spot on eye’ , no symptoms
• Pigmented nodule, angle invasion (+/- glaucoma), cataract, pupil distortion (corectopia), iris neovasc, pigment dispersion
• MX: refer, surgical excision (iridectomy, iridotrabeculectomy), enucleation

Question 9

Iris naevus vs. iris melanoma

Answer 9

ABCDEF

• age - young <40 years
• blood - hyphaema
• clock hour inferiorly
• diffuse
• ectropion
• feathery margins

Question 10

Features of retinoblastoma

Answer 10

• Most common tumour of childhood, mostly unilateral, trilateral possible
• leukocoria, strabismus, uveitis, glaucoma, proptosis, elevated lesion (white, pink)- may grow into vitreous or subretinal space, cause haems, RD
• MX: examine fundi of children with squint, refer, radiotherapy, photocoagulation/ cryotherapy, enucleation

Question 11

Features of rhabdomyosarcoma

Answer 11

= most common primary orbital tumour of childhood
- risk spread from skull to orbit
- rapid progressive ptosis, squint, gaze restriction
- refer - radiotherapy, chemotherapy
severe cases: exenteration of orbit

Question 12

Features of Angiomatosis retinae (Von Hippel Lindau disease)

Answer 12

= retinal vascular tumour

• MA –> small red nodule –> large red/orange tumour
• tortuous vessels, exudate (leaky), vitreous haem, serous RD

Question 13

Features of primary intraocular lymphoma

Answer 13

= tumour of lymphoid tissue/ lymphocytes

• vitreous cells, multifocal intraretinal or subretinal infiltrates
• radiotherapy, chemo

Question 14

Features of choroidal osteoma

Answer 14

= benign bone-like choroidal tumour (bony plate in choroid)

• bony gold/orange plate-like lesion
• may disrupt RPE and sensory retina - subretinal neovasc
• mx: benign, may extend under macula (affect vision)