Unilateral Yellowish Eye in a Woman With an Intraocular Mass

A 65-year-old woman was referred with a 6-week history of blurry vision, ocular pain, and subconjunctival yellow discoloration in the left eye. Suspicious retinal detachment and intraocular mass were identified, which raised concerns for choroidal melanoma. No symptoms or signs were reported in the right eye. Her ocular history included bilateral cataract surgery 5 years prior. Review of systems yielded negative results, including for ocular trauma, jaundice, and cutaneous melanoma. She had no history of tobacco use.

On examination of the left eye, visual acuity was hand motion, and intraocular pressure was 8 mm Hg. The anterior segment showed diffuse conjunctival chemosis of yellow hue, low-grade aqueous reaction, and pseudophakia (Figure 1A). On the fundus evaluation, large pockets of subretinal fluid suggested choroidal effusion based on marked fluid shifting with head position. B-scan ultrasonography confirmed 4-quadrant choroidal hemorrhage and partially mobile serous retinal detachment. B-scans also exhibited a solid lesion from the 6- to 10-o’clock meridians with irregular shape and variable internal reflectivity, measuring 5.8 mm in height. Magnetic resonance imaging was requested to delineate the mass from the surrounding clot (Figure 1B). In the interim, she received oral steroids aiming to contain the abundant exudation and topical atropine for pain, evolving with minimal clinical improvement on these features.