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.
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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.
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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.
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 (firstname.lastname@example.org).
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.
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