Malignant Choroidal Melanoma With Acute Proptosis

Hemalatha Chandrakanthan

Purpose : To recognize atypical presentation of choroidal melanoma

Method : Case Report
A 37 year old female presented to our eye clinic with sudden onset of protrusion of her left eye for a 4 month duration which was progressively worsening in severity. She claimed that her vision had been poor in the left eye for 8 years and had seen the doctor twice but eventually defaulted her follow-ups. On examination, there was absence of light perception visual acuity, prolapsed conjunctiva, opaque cornea with non-axial proptosis.

CT Scan : Extensive intraorbital mass which was non- homogenous and non – encapsulated
Other examinations including full blood count, Erythrocyte Sedimentation Rate, Hepatic and Renal Functions Chest X –Ray and Ultrasound Abdomen were all normal.

Results : After clinical evaluation, exenteration of left eye was done.
The histopathological examination confirmed the diagnosis of malignant choroidal melanoma.

Conclusion : Most choroidal melanomas are asymptomatic. Symptomatic tumours cause reduced visual acuity, metamorphopsia, visual field loss and floaters. In this case of choroidal melanoma, the presentation was acute proptosis which is a very rare presentation. In view of this uncommon clinical feature supplementary tests and clinical follow-ups were important for the correct diagnosis.