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2007 Series -  May 29, 2007 Lecture 31 of 52  NEXT»

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This is a 50-year-old family practitioner who presented to a general ophthalmologist for a routine vision exam and prescription for reading glasses.  Rather shockingly, the patient was found to have 20/20 vision in his right eye, but hand motion vision (at 8’) in his left eye.  Even more shocking, he was unaware of this impairment. 

The ophthalmologist was suspicious for a metastatic tumor in the patient’s left eye and referred him onward to a retina specialist.

1.  Which of the following is NOT true of the patient’s ultrasound (both ‘A’ and ‘B’ scan)?   

a. a shallow retinal detachment is evident
b. the mass has a “collar-button” configuration
c. the optic nerve appears to be involved
d.  extrascleral tumor extension is evident
e. the spikes exhibit medium reflectivity

2.  The patient underwent CT scans of the chest and abdomen.  Knowing this, and using all of the images available to you, would you then feel comfortable about the patient’s SYSTEMIC prognosis?  

a. probably so; as the liver is the foremost site of metastases for intraocular melanomas
b. probably so; application of a radioactive plaque should easily eliminate all existing tumor
c. probably not; the retinal detachment will likely advance, leaving the patient with little useful vision in the eye
d.  probably not; it is likely that this patient comes from a “cancer family”, and one could reasonably expect tumor development in the fellow eye
e. probably not; even though the scans are normal, ANY extrascleral extension is an ominous sign

For answers to the above, click here on or after June 5, 2007.


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