|Year : 1968 | Volume
| Issue : 2 | Page : 67-69
Malignant melanoma of choroid presenting as panophthalmitis
NN Sood, A Ratnaraj
Department of Ophthalmology, Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry-6, India
N N Sood
Department of Ophthalmology, Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry-6
|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 2013 May 19];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  ), 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  , REESE  . 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  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.
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.
(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|| |
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|| |
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|| |
We are grateful to Prof. Balasubramaniam for providing the histopathology report.
| References|| |
|1.||DUKE ELDER, S.: System of Ophthalmology. Vol. IX, Diseases of the Uveal tract. Henry Kimpton, London, 1966, p. 846. |
|2.||MACKLEY, T. A. (Jr.) and TEED, R. W. (1958): - A.M.A. Arch. Ophth. 60, 475. |
|3.||REESE, A. B., Tumours of Eye. Hoeher Medical Div. N. Y. 1963. 2nd Ed. P. 252. |
|4.||SPAULDING, A.' G., and NAUMANN, G. (1966): A. M. A. Arch. Ophth. 76, 578. |
[Figure - 1], [Figure - 2]