Iridociliary Melanoma
A 57-year-old man presented to the ophthalmology clinic with a 4-month history of progressively worsening pain and decreasing vision in the right eye. Using the affected eye alone, at a distance of 1 m, he was only able to count fingers. Examination showed a pigmented nodule in the inferior part of the iris, with multiple smaller pigmented lesions. The intraocular pressure was 63 mm Hg (reference range, 10 to 21), and fundus examination was notable for marked cupping of the right optic disk. Ocular ultrasonography revealed that the mass involved the iris and ciliary body. Iridociliary melanoma with secondary glaucoma was suspected. Primary enucleation of the right globe was performed, and histologic analysis confirmed the diagnosis. Evaluation for extraocular metastases was negative. Early recognition of ocular melanomas with ophthalmology referral is important because it may be possible to treat small tumors with radiation therapy or less invasive surgeries. Regular surveillance was recommended, but the patient was lost to follow-up after surgery.