Intraocular tumours

Question 1

TTT

Answer 1

Transpupillary thermotherapy

Question 2

Iris tumours

Answer 2

Naevus vs melanoma
Naevus spot diameter <3mm and <1mm thick
Melanoma spot diameter >3mm and >1mm thick
Suspicion: growth, vascularity, increased pressure, peak pupil
Iris metastasis

Question 3

Ciliary body melanoma

Answer 3

12% of uveal melanomas

Presents with dilated episcleral vessels, lens sublaxation, uveitis, cataract

Question 4

Choroidal melanoma

Answer 4

80% of uveal melanomas
Age: 50/60yo
Size: small, medium, large
Complaint: asx or ball of light moving across visual field
Fundoscopy: brown lesion
Rx: TTT, radiotherapy, enucleation, exentaration

Question 5

Nevus to melanoma

Answer 5

Thickness >2mm
Fluid subretinally
Symptoms
Orange pigment on top of lesion
Margin within 3mm of optic disc
USG hollowness
Halo
Drusen absent

Question 6

Choroidal haemangioma

Answer 6

Benign circumscribed or diffuse vascular hamartoma
SEEN IN STURGE WEBER SYNDROME
IOP measurement NB!
Affects RPE and retinal layers therefore can affect vision
Tx: observation, PDT, TTT, radiotherapy,

Question 7

Retinoblastoma description

Answer 7

Most common primary childhood tumour
Presents at 1-2yo
Sporadic or inherited
Knudson’s two hit hypothesis

Question 8

Retinoblastoma clinical features

Answer 8

Leukocoria (uni/bilateral)
Squint
Orbital inflammation
White round mass
Prominent vessels + vitreous seeds (look like pus in ant chamber but aren’t therefore pseudo)
W/wo glaucoma, pseudohypopyon, metastasis

Question 9

Retinoblastoma investigations

Answer 9

U/S
CT
MRI
Looking for typical white mass indicating calcification

Question 10

Retinoblastoma treatment

Answer 10

Cryotherapy
Laser
Radiotherapy
Chemotherapy
Enucleation (need to know extent of CNII involvement - if spread into CNII, this method will leave the cancer behind)
Avoid exanteration when possible - disfiguring and can cause spread

Question 11

RPE tumours

Answer 11

Congenital hypertrophy of the RPE
Common benign proliferation of the RPE
Solitary or grouped - “bear tracks”
Assoc with FAP, colon ca, CNS tumours therefore screen

Question 12

Lymphoma description

Answer 12

Very uncommon tumour of eye but needs to be part of differential because it affects vision and is life-threatening
Ocular CNS vs systemic type

Question 13

Lymphoma types

Answer 13

Ocular CNS = uveitis/other retinitis-like picture

Systemic type = rare w very few signs and choroidal thickening

Question 14

Lymphoma investigations

Answer 14

FNA
Biopsy
IL10:IL6 ratio>1
MRI
LP
Abdominal imaging

Question 15

Lymphoma referral

Answer 15

Oncologist

Physician

Question 16

Lymphoma treatment

Answer 16

Radiotherapy

Chemotherapy

Question 17

Conjunctival sarcoma

Answer 17

HIV patients

Easily excised if minimal spread