Intraocular tumours

Important topics to read about:

Ophthalmology Examinations Review

Section "8" Topic (9) : Iris nodules.
Topic (10) : choroidal melanoma & COMS
Section "9" Topic (8) : Retinoblastoma.

Wills Eye Manual

Leukocoria

DD of subretinal mass in an adult:

Melanotic (Pigmented)

Non Tumour:
Subretinal blood
hgic CD

Tumour:
Nevus
CHRPE
Melanoma
Melanocytoma

Amelanotic mass

Non tumour
Inflammatory granuloma
Subretinal scar

Tumour:
Haemangioma
Osteoma
Amelanotc melanoma
secondaries

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Melanoma of the choroid

How to differentiate a choroidal naevus from a melanoma?

= To Find Small Ocular Melanoma

Shields et al. Can J Ophthalmol, 1995. 2004 Jun;39(4):351-7

T= Thickness greater than 2 mm,

F = subretinal fluid,
S = symptoms,
O = orange pigment,
M = margin touching optic disc

o 0 feature = 3% risk of growth into melanoma at 5 y

o 1 feature = 38%
o >2 = > 50%

Tumours with no feature - probably nevi

Most tumours with > 2 risk factors- probably small melanomas

Collaborative ocular melanoma study (COMS) tumour classification:

diameter height
neavus 1-5 0-1
Small 5-10 1-3
meduim 10-16 4-8
large >16 >8

Notes on melanoma diagnosis:

Diagnosis:
Usually examination and B scan ultrasound are enough
If there is suspicion that lesion may be subretinal blood
FFA/ Doppler/MRI
To detect possible extensions:
0 B scan ultrasound is usually enough
MRI
Secondaries:
Liver enzymes and abdominal ultrasound
CXR (lung mets are uncommon)

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Dd of leucocria:
RB until proven otherwise (50%)
commom causes:
o PHPV (30%)
o Toxocara (15%)
o Coats (15%)
o Cataract
Others
retina/vitreous
ROP
FEVR
IP
Rretinal dysplasia
Norrie's
Toxocara
RD
optic nerve
coloboma
medullated nfl

Ocular sins of leukemia:

Orbit: proptosis- chloroma in CML
Lids: infiltration
Conjunctiva: hge/ tortous vs due to hyperviscosity
Anterior segment: hypopyon/hyphema/iris metastases/heterochromia/glaucoma
Posterior segment: dilated etinal vs/hge/exudate/cotton wool spots/choridal
infiltration/opportunistic infection
Optic nerve: carcimomatous optic neuropathy
Neuro-opthalmic: papilledema/crial nerve palsy esp 6th n palsy/Horner $

Ocular lymphoma:
Orbit: proptosis- +/- bilateral// lacrimal gland elargement
Lids: infiltration rubbery masses
Conjunctiva: salmon pink subconjunctival infiltration
Anterior segment: hypopyon/hyphema/iris metastases
Posterior segment: resistant uveitis/vitritis/ subretinal infiltration
Optic nerve: carcimomatous optic neuropathy
Neuro-opthalmic: papilledema/6th n palsy/Horner $/hemiplegia

Multiple myeloma:
Orbit: myeloma lesions
Lids: infiltration
Conjunctiva: hge/ tortous vs due to hyperviscosity
Anterior segment: crystalline keratopathy
Posterior segment: dilated etinal vs/hge/exudate/cotton wool spots
Neuro-opthalmic: multiple lytic lesions

Paraneoplastic syndromes:
Eaton lambert $: Oat cell lung cancer
Opsoclonus: meduuloblastoma/lung cancer
Bilateral diffuse uveal mealoncytic proliferation (BDUMP): GIT/ovarian cancer
Retinopathy:
o Carcinoma associated retinopathy (CAR): lung cancer/cervical cancer
o Melanoma associated retinopathy (MAR): cutaneous melanoma

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