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A 53-year-old man presented to his ophthalmologist for a newly noticed bulging left eye. He reported several eyeglass prescription changes in the left eye over the past 2 years and frequent ipsilateral tearing. He denied ocular discomfort, headaches, or double vision. He had a distant history of right temple melanoma that was excised with clean margins and accompanied by a negative sentinel lymph node biopsy result.
On examination, he was found to have a best-corrected visual acuity of 20/20 OD and 20/40 OS, with a normal pupillary response and intact color vision bilaterally. He had a mild limitation of left abduction and supraduction. He had 5 mm of relative left proptosis, with moderate resistance to retropulsion of the left globe. No change in globe position was appreciated with systolic pulsations or the Valsalva maneuver. Anterior segment examination results were normal bilaterally. Dilated fundus examination results of the left eye revealed an abnormality of the posterior pole (Figure 1A), which was confirmed on fluorescein angiography (Figure 1B).
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Choroidal folds secondary to an orbital cavernous hemangioma
C. Magnetic resonance imaging of orbits
Choroidal folds are formed by corrugations of the choroid and retinal pigment epithelium (RPE), which appear clinically as alternating light and dark bands. This clinical finding most commonly appears in the posterior pole.1 Choroidal folds are further accentuated on fluorescein angiography and optical coherence tomography. B-scan ultrasonography may additionally demonstrate retinal and choroidal thickening with a flattening of the posterior globe. Choroidal folds should be differentiated from retinal folds, which are lighter and less distinct on fluorescein angiography and are commonly associated with optic disc edema (ie, Patton lines) or areas of retinal traction, as in epiretinal membranes or proliferative vitreoretinopathy.2
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Corresponding Author: Natalie Homer, MD, TOC Eye and Face, 3705 Medical Pkwy, Ste 120, Austin, TX 78705 (firstname.lastname@example.org).
Published Online: August 29, 2019. doi:10.1001/jamaophthalmol.2019.3090
Conflict of Interest Disclosures: Dr Nakra is a shareholder of Global Beauty Science, Inc. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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