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Spot Diagnosis - Opthalmology

Discussion in 'Spot Diagnosis' started by neo_star, Jan 12, 2013.

  1. neo_star

    neo_star Moderator

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    sd - opthalm.jpg

    What's the Diagnosis ?
     

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  2. Mishary almalkey

    Mishary almalkey Active member

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    looks like Iris Melanoma but still i consider there as DD:
    1-Metastatic
    2-Nevi
    3-Iris cysts
    4-Iridocorneal endothelial syndrome
    5-Primary iris pigment epithelial tumors
     

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  3. u4534590

    u4534590 Active member

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    Doesn't look like a hyphema so my guess would be melanoma or naevi - I don't know any others!
     

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  4. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

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    Hyphema. (Blood behind cornea.)
     

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  5. Walkov

    Walkov Famous Member

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    hyphema
     

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  6. neo_star

    neo_star Moderator

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    Answer: Iris Melanoma

    But without Hx and Eye exam - all differentials are valid

    I will try and break up the differentials and sum up the main differentials in a slide.

    History
    - present from birth and no change - naevus
    - present from birth but rapid growth noticed - most likely tranformed into melanoma
    - appeared suddenly - can be metastatic...check for melanoma elsewhere

    Slit lamp
    - good vascularity - likely to be melanoma
    - poor or no vascularity - likely to be benign ( nevus )
    - the lesion transilluminates ( cyst )
    - if hyphema is present in addition, then it's likely to be melanoma ( blood from the leaky vasculature )

    Gonioscope
    - will help look for encroachment of the angle

    Since Iris melanoma is not expected to spread widely or even locally...close follow up with slit lamp and gonioscopy is the key. If it looks threatening then iridectomy.

    [​IMG]

    Iridocorneal Endothelial syndrome, is beyond the scope of this discussion ( actually beyond my scope :hhh: ). Those interested please visit
    - http://eyewiki.aao.org/Iridocorneal_Endothelial_Syndrome_and_Secondary_Glaucoma

    Xtra Edge

    In general, uveal melanomas are three times more common in patients with blue/grey than brown irides. They are extremely rare in blacks and there is no sexual predominance. Conditions associated with or predisposing to uveal melanomas are: (a) fair skin, (b) light iris colour, (c) numerous cutaneous naevi, (d) congenital ocular melanocytosis, (e) oculodermal melanocytosis (naevus of Ota), (f) uveal melanocytoma, (g) dysplastic cutaneous naevi, (h) familial cutaneous melanoma and (i) NF1. About 8% of uveal melanomas arise in the iris. The prognosis is very good and only about 5% of patients develop metastases within 10 years of treatment.

    ref - Kanski, 7th ed ( but in my own words )

    Ultrasound biomicroscopy ( if avaialable ) can throw further light on the nature ( cyst vs nevus vs melanoma ) and depth of the lesion.

    ref - Intraocular Tumors: An Atlas and Text
     

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  7. dr.angela

    dr.angela Bronze Member

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    Hyphema
     

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