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    Can You Guess July's Mystery Condition?

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    Make your diagnosis in the comments, and look for the answer in next month’s Blink.

    External photo of an enlarging lesion in lower eyelid


    Last Month’s Blink

    Exteriorized Ciliary Body Melanoma

    Written by Rym Maamouri, PhD, Wijden Nabi, MD, and Monia Cheour, MD. Photo by Dr. Maamouri. All are at the Habib Thameur Hospital and the University of Tunis El Manar in Tunisia.

    Fig 1: External photo with eyelid raised. Fig 2: Gonioscopy. Fig 3: Gonioscopy after pupillary dilation.

    A 66-year-old man pre­sented with redness and pain in his left eye that had persisted for more than two months. He had previously been diagnosed with presumed unilat­eral glaucoma and treated with prostaglandin analogue eyedrops at that time.

    He was referred to our depart­ment for evaluation because of continuing blurred vision in the left eye. Objective refraction was –0.25/–0.75 × 90 and –2.5/–1.25 × 70 in the right and left eyes, respectively; best-corrected VA was 20/20 in the right eye and 20/63 in the left.

    When the left upper eyelid was raised, a localized subconjunctival hyperpigmented mass was visible (Fig. 1). Slit-lamp examination of the left eye revealed fine pigment­ed keratic precipitates and pig­mented cells in the anterior chamber, which was markedly shallow in the nasal aspect, with posteri­or synechiae. IOP was 38 mm Hg. On gonioscopy, the angle was heavily pigmented 360 degrees by abnormal brown cells (Fig 2).

    After pupillary dilation, gonioscopy revealed a hyper­pigmented ciliary mass between 9 and 10 o’clock in contact with the lens, with a mild and diffuse phacosclerosis (Fig. 3). The fundus examination showed no cells in the vitreous, and the patient’s cup-to-disc ratio was 0.3 in the right eye and 0.7 in the left without disc pallor. Examination of the right eye was unremark­able. The left eye was diagnosed as harboring a circumscribed and exteriorized ciliary body mel­anoma infiltrating the anterior chamber.

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