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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 2  |  Page : 67-69

Malignant melanoma of choroid presenting as panophthalmitis


Department of Ophthalmology, Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry-6, India

Date of Web Publication22-Dec-2007

Correspondence Address:
N N Sood
Department of Ophthalmology, Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry-6
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Sood N N, Ratnaraj A. Malignant melanoma of choroid presenting as panophthalmitis. Indian J Ophthalmol 1968;16:67-9

How to cite this URL:
Sood N N, Ratnaraj A. Malignant melanoma of choroid presenting as panophthalmitis. Indian J Ophthalmol [serial online] 1968 [cited 2020 Jul 9];16:67-9. Available from: http://www.ijo.in/text.asp?1968/16/2/67/37495

The treatment of a blind eye with opaque media, but otherwise quiet eye presents the ophthalmologist with a serious problem. However, some of these eyes may be harbour­ing an unsuspected malignant mela­noma is well recognised. (MACKLEY and TEED [2] ), so that enucleation in a painful blind eye is advisable. The clinical picture of malignant mela­noma may be considerably modified by the inflammation which may pre­cede the development of melanoma or may result from the necrotic tissue of a melanoma. DUKE ELDER [1] , REESE [3] . Such an inflammation may be of plastic type, rarely puru­lent and marked necrotic melanomas may present with signs of severe uveitis, endophthalmitis or panoph­thalmitis. MACKLEY AND TEED [2] point out that some of the malig­nant melanomas presenting clini­cally as panophthalmitis, may have ocular contents eviscerated without subjecting the tissues to histopatho­logy.

We are recording a patient who presented clinically as panophthal­mitis, evisecerated contents of which showed it to be a necrotic melanoma.

Case Report:

S - a sixty years old male attended the ophthalmic O.P.D. of The Gene­ral Hospital, Pondicherry with a his­tory of pain and watering of the right eye of three days duration. The patient gave a previous history of injury to the right eye with a stick 15 years back and for which he had some native treatment. When the acute phase subsided, he noted that the vision was grossly affected.

The eye remained quiet for many years but had redness and pain in the eye intermittently in the past one year. Few days prior to seeking me­dical relief the patient developed severe pain and redness and water­jig of the right eye.

Clinical examination revealed a well developed but poorly nourish­ed male with multiple black spots all over the body. Examination of chest and abdomen was normal. Local Examination: of the right eye showed marked swelling of the lids chemosis of bulbar conjunctiva with mucopurulent discharge in the lower fornix and medial canthus. The cornea had completely sloughed off except for the peripheral 1 - 2 nom. The gap in the cornea was occupied by the uveal tissue covered over at places by muco pus. There was no perception of light. Lymph codes were normal.

The left eye had an immature cata­ract, with only a peripheral red glow. A provisional diagnosis of panoph­thalmitis following the breakdown of corneal opacity was made as the globe appeared firm, the possibility of malignant melanoma could not be ruled out.

As the patient was unwiling for any surgery, treatment with antibio­tics was instituted. In view of the persistence of severe pain the patient later agreed for surgery.

On the 3rd clay of admission, the evisceration was performed because of the presence of frank infection. The contents consisted of purulent material along with friable black bits of tissue. The eviscerated material was sent for histopathological exami­nation.

Histopathology:

(Report No. 2031/65) Material consisted of multiple dark brown friable bits. Topographic orienta­tion was difficult because of damage to the anterior segment, removal of contents in bits and necrosis of the tissues. Spindle cells and occasional nucleoli were visible. There were focal collections of melanophores. The picture was consistent with diag­nosis of necrotic melanoma [Figure - 1],[Figure - 2].

In view of the histo-pathological report, the patient was advised to have the removal of the remains of the sclera, which he refused. The pa­tient has not returned for further follow up.


  Discussion Top


Panophthalmitis as a mode of pre­sentation of malignant melanoma is not common. In the series presented by Mackley & Teed (1958) only six cases out of 212 were clinically known to have panophthalmitis or had evisceration done (latter pre­sumably for panophthalmitis). In one of the cases a melanoma deve­loped in an eviscerated eye in which some uveal tissue must have been left behind. The evisceration took place five years previous to the dis­covery of the orbital mass. No re­cord exists of the examination of the contents of evisceration.

Reese (1963) considers that the necrotic tissue of r melanoma can produce an inflammatory reaction just as severe as any provoked by bacterial toxins, cytotoxins, diffuse throughout the globe and in severe cases affect all the structures of the eye. Tumour necrosis may also set up a sufficiently severe reaction to produce collateral inflammation and cellulitis in the orbit.

The present case presented clini­cally as frank panophthalmitis. His­tological examination of the evisce­rated material confirmed the diagnosis of a necrotic melanoma. In view of this, removal of the scleral coat was advised which the patient refused.

SPALDING AND NAUMANN (1966) reported an unsuspected malig­nant malanoma in an eye removed because of endophthalmitis resulting from trauma. The authors point out that a perfectly obvious cause for pa­nophthalmitis or endophthalmitis, such as trauma, does not rule out other more serious unsuspected causes.


  Summary Top


A case of malignant melanoma presenting as frank panophthalmitis is described. Histopathological ex­amination of the eviscerated contents showed it to be a necrotic melanoma.


  Acknowledgment Top


We are grateful to Prof. Balasub­ramaniam for providing the histopa­thology report.[4]

 
  References Top

1.
DUKE ELDER, S.: System of Oph­thalmology. Vol. IX, Diseases of the Uveal tract. Henry Kimpton, London, 1966, p. 846.  Back to cited text no. 1
    
2.
MACKLEY, T. A. (Jr.) and TEED, R. W. (1958): - A.M.A. Arch. Ophth. 60, 475.  Back to cited text no. 2
    
3.
REESE, A. B., Tumours of Eye. Hoe­her Medical Div. N. Y. 1963. 2nd Ed. P. 252.  Back to cited text no. 3
    
4.
SPAULDING, A.' G., and NAUMANN, G. (1966): A. M. A. Arch. Ophth. 76, 578.  Back to cited text no. 4
    


    Figures

  [Figure - 1], [Figure - 2]



 

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