[Skip to Content]

Quiz

Oncology

Unilateral Yellowish Eye in a Woman With an Intraocular Mass

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: March 17, 2022

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Leonardo Lando, MD¹;

Filiberto Altomare, MD¹;

Hatem Krema, MD, MSc¹

Author Affiliations

¹Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada

Read article on JAMA Network

Read Case Take Quiz Answer

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.

Take Quiz

Please finish quiz first before checking answer.

Choroidal metastasis from lung adenocarcinoma

D. Rule out an occult systemic neoplasm

Choroidal effusion consists of serous-hemorrhagic fluid accumulation in the suprachoroidal space typically encountered in trauma, surgery, or uveitis scenarios.¹^,2 It can produce a mass effect simulating tumors² or be the presenting feature of ocular neoplasms,³ requiring elucidation as to its origin and nature. In this patient, disproportional choroidal exudation in the context of a solid lesion unresponsive to steroid therapy was strongly suggestive of malignancy.

The yellow discoloration noted in only 1 eye was unusual and likely reflected a subacute process related to long-standing choroidal fluid buildup.⁴ Unlike the scleral impregnation with bilateral involvement classically seen in jaundice,⁵ the ocular coloration changes developed in this patient indicated a local mechanism, mediated by fluid extravasation from the choroidal compartment to the subconjunctival space.⁴ Therefore, screening for causes of bilirubin elevation, such as liver dysfunction and biliary tract obstruction (choice A), would not be the first step taken.

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Leonardo Lando, MD, Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Princess Margaret Cancer Centre/University Health Network, 610 University Ave, Toronto, ON M5G 2M9, Canada (leonardolando23@gmail.com).

Published Online: March 17, 2022. doi:10.1001/jamaophthalmol.2021.5683

Conflict of Interest Disclosures: Dr Lando reported grants from Pan-American Association of Ophthalmology Sear Scholarship 2019. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information. We thank Daniel Weisbrod, MD, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada, for his contribution to the article’s written composition. Dr Weisbrod was not compensated for his contribution.

References

Gass JD , Jallow S . Idiopathic serous detachment of the choroid, ciliary body, and retina (uveal effusion syndrome). Ophthalmology. 1982;89(9):1018-1032. doi:10.1016/S0161-6420(82)34685-0 PubMed Google Scholar Crossref

Elagouz M , Stanescu-Segall D , Jackson TL . Uveal effusion syndrome. Surv Ophthalmol. 2010;55(2):134-145. doi:10.1016/j.survophthal.2009.05.003 PubMed Google Scholar Crossref

Sneed SR , Byrne SF , Mieler WF , Nicholson DH , Olsen K , Hughes JR . Choroidal detachment associated with malignant choroidal tumors. Ophthalmology. 1991;98(6):963-970. doi:10.1016/S0161-6420(91)32195-X PubMed Google Scholar Crossref

Tolentino FI , Brockhurst RJ . Unilateral scleral icterus due to choroidal hemorrhage. Arch Ophthalmol. 1963;70:358-360. doi:10.1001/archopht.1963.00960050360015 PubMed Google Scholar Crossref

Fargo MV , Grogan SP , Saguil A . Evaluation of jaundice in adults. Am Fam Physician. 2017;95(3):164-168.PubMed Google Scholar

Mathis T , Jardel P , Loria O , et al. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res. 2019;68:144-176. doi:10.1016/j.preteyeres.2018.09.003 PubMed Google Scholar Crossref

Shields CL , Shields JA , Gross NE , Schwartz GP , Lally SE . Survey of 520 eyes with uveal metastases. Ophthalmology. 1997;104(8):1265-1276. doi:10.1016/S0161-6420(97)30148-1 PubMed Google Scholar Crossref

Shah SU , Mashayekhi A , Shields CL , et al. Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients. Ophthalmology. 2014;121(1):352-357. doi:10.1016/j.ophtha.2013.07.014 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.