[Skip to Content]
[Skip to Content Landing]

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

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.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

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.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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
1.
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)34685-0PubMedGoogle ScholarCrossref
2.
Elagouz  M , Stanescu-Segall  D , Jackson  TL .  Uveal effusion syndrome.   Surv Ophthalmol. 2010;55(2):134-145. doi:10.1016/j.survophthal.2009.05.003PubMedGoogle ScholarCrossref
3.
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-XPubMedGoogle ScholarCrossref
4.
Tolentino  FI , Brockhurst  RJ .  Unilateral scleral icterus due to choroidal hemorrhage.   Arch Ophthalmol. 1963;70:358-360. doi:10.1001/archopht.1963.00960050360015PubMedGoogle ScholarCrossref
5.
Fargo  MV , Grogan  SP , Saguil  A .  Evaluation of jaundice in adults.   Am Fam Physician. 2017;95(3):164-168.PubMedGoogle Scholar
6.
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.2018.09.003PubMedGoogle ScholarCrossref
7.
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)30148-1PubMedGoogle ScholarCrossref
8.
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.2013.07.014PubMedGoogle ScholarCrossref
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close