This is an 80 yo female patient. One of her eys has choroidal groth, presumably – choroidal melanoma. Other eye is blind and painful (was treated long time ago with retrobulbar neurolytics elsewhere).
Her VA was NLP in RE, and 6/24 in LE. Her right eye findings are irrelevant for the case, the only thing that really matters – it’s that she has only one seeing eye and it contains big choroidal mass.
Dilated fundus exam of left eye: macular scars + folds + peripapillary atrophy. In superior mid-periphery gross black-grey choroidal mass was revealed.
Left eye ultrasound revealed anisointense choroidal mass of upper periphery with internal hypointensivity.
Tentative diagnosis: Choroidal Melanoma; incipient cataract. Single seeing eye.
My plan was as follows: CXR, breasts screening, abdomen US, FBC, FBS, LFTs, urea and creatinine were ordered (and all these were unremarkable), and the patient was referred to the tirtiary hospital for further examinations: ultrasound biomicroscopy for RE, and further choroidal mass evaluation (i.e. MRI with contrast) and management in cooperation with Cancer Center.
There are high chances for enucleation (and complete vision loss) due to the size of tumor and abscence of brachytherapy option in the country.