Melanoma and Other Tumors Melanoma is the most common primary tumor of the eye (Fig. 29-18). It causes photopsia, an enlarging scotoma, and loss of vision. A small melanoma is often difficult to differentiate from a benign choroidal nevus. Serial examinations are required to document a malignant pattern of growth. Treatment of melanoma is controversial. Options include enucleation, local resection, and irradiation. Metastatic tumors to the eye outnumber primary tumors. Breast and lung carcinoma have a special propensity to spread to the choroid or iris. Leukemia and lymphoma also commonly invade ocular tissues. Sometimes their only sign on eye. | Chapter 029. Disorders of the Eye Part 17 Melanoma and Other Tumors Melanoma is the most common primary tumor of the eye Fig. 29-18 . It causes photopsia an enlarging scotoma and loss of vision. A small melanoma is often difficult to differentiate from a benign choroidal nevus. Serial examinations are required to document a malignant pattern of growth. Treatment of melanoma is controversial. Options include enucleation local resection and irradiation. Metastatic tumors to the eye outnumber primary tumors. Breast and lung carcinoma have a special propensity to spread to the choroid or iris. Leukemia and lymphoma also commonly invade ocular tissues. Sometimes their only sign on eye examination is cellular debris in the vitreous which can masquerade as a chronic posterior uveitis. Retrobulbar tumor of the optic nerve meningioma glioma or chiasmal tumor pituitary adenoma meningioma produces gradual visual loss with few objective findings except for optic disc pallor. Rarely sudden expansion of a pituitary adenoma from infarction and bleeding pituitary apoplexy causes acute retrobulbar visual loss with headache nausea and ocular motor nerve palsies. In any patient with visual field loss or optic atrophy CT or MR scanning should be considered if the cause remains unknown after careful review of the history and thorough examination of the eye. Figure 29-18 Sourcai Fiuo 5. DL Br un- ild E H uc r SLr Longo DL. Jimgion JL U ic tto Ji Harrisva i o Intern IM dionn. 17th Edition http VMW. Copvnoht O Th Hrtrao-HlU Comp ni r Inc All Hahn trrtNrf. Proptosis When the globes appear asymmetric the clinician must first decide which eye is abnormal. Is one eye recessed within the orbit enophthalmos or is the other eye protuberant exophthalmos or proptosis A small globe or a Horner s syndrome can give the appearance of enophthalmos. True enophthalmos occurs commonly after trauma from atrophy of retrobulbar fat or fracture of the orbital floor. The position of the .
