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Optic Nerve Tumors

Posted on May 9, 2016

Choroidal melanoma of the optic nerve
Choroidal melanoma of the optic nerve - This circumpapillary melanoma has grown as to cover and extend into the optic nerve.

Melanocytoma
Melanocytoma - Juxtapapillary with feathered edges (arrow) and extension on to the surface of the optic nerve.

Optic nerve melanocytoma
Optic nerve melanocytoma - Small, juxtapapillary

Ultrasound topography of a juxtapapillary melanocytoma

Metastatic Ocular Tumors

Posted on May 9, 2016

Anterior segmentmet breast
Breast metastasis to the iris and anterior segment

Breast cancer metastasis
Breast cancer metastasis in the right eye

Breast cancer metastasis
Breast cancer metastasis to the choroid of the right eye - same patient

Breast metastasis
Breast metastasis can be seen on either side of the iris (arrows)

Choroidal metastasis
Choroidal metastasis - Wilm`s tumor origin

Choroidal metastasis from a lung
Choroidal metastasis from a lung (adenocarcinoma) found in the macula

Choroidal metastasis
Choroidal metastasis with secondary serous retinal detachment (arrow).

Iris Metasis Lung
Lung metastasis to the iris and anterior segment .jpeg

Multifocal choroidal metastasis
Multifocal choroidal metastasis (arrows) from a breast cancer primary

Thyroid cancer metastasis
Thyroid cancer metastasis to the juxtapapillary choroid of the eye.

Lateral Orbitotomy After-Images

Posted on May 9, 2016

Close up
Two years after lateral orbitotomy

Front View
Two years after lateral orbitotomy

Iris Tumors

Posted on May 9, 2016

Multiple iris nevi
Multiple iris nevi on gonioscopy

Iris neovascularization
Iris neovascularization secondary to a medium-sized choroidal melanoma with a long-standing exudative retinal detachment (prior to treatment).

Iris Nevus
Iris Nevus - Slit lamp photography documents the appearance and distribution of this rather benign appearing iris nevus.

Iris Nevus
Iris Nevus - Note the lack of ectropion uveae, correctopia, intrinsic vascularity, or pigment dispersion.

Iris pigment epithelium (IPE) Cyst

Iris Stromal Atrophy

Iris stromal cyst
Iris stromal cyst as seen on gonioscopy

Iris Varix

Juvenile Xanthogranuloma
Juvenile Xanthogranuloma in a 2 year old male. This case had no systemic disease and the lesion resolved with steroid therapy.

Iris Melanoma
Iris Melanoma with pigment liberation (arrow) onto the surface of the iris stroma.

Neuro-epithelial iris cyst
Neuro-epithelial iris cyst typically presents as a bulge in the iris stroma.

Neuroepithelial iris cyst
Neuroepithelial iris cyst - Typically presents as a focal protrusion of the iris stroma anterior to the cyst.

Neuroepithelial iris cyst
Neuroepithelial iris cyst - Gonioscopic image clearly demonstrates focal anterior displacement of the iris stroma (arrow).

Ocular Melanosis
Ocular Melanosis - Slit lamp photography demonstrates episcleral and uveal pigmentation associated with ocular melanosis.

Pearl cyst of the iris
Pearl cyst of the iris - Epithelial implantation cyst.

Small iris melanocytoma
Small iris melanocytoma - note no evidence of ectropion, intrinsic vascularity, or sector cataract

Suspicious Iris Nevus
Suspicious Iris Nevus - Note the ectropion uveae, correctopia and the variable brown and "tapioca" coloration.

Iris Flocculi
Iris Flocculi - Hi power slit lamp photograph reveals multiple pigmented flocculi at the pupillary margin.

Gonioscopic appearance
Gonioscopic appearance of pigment deposition in the anterior chamber angle (arrow)

Intrinsic vascularity
Intrinsic vascularity (arrow) in a suspicous iris nevus

Intrinsic vascularity
Intrinsic vascularity seen in a suspicious iris nevus

IPE cyst
IPE cyst that eroded through the iris stroma

Iridociliary Melanoma
Iridociliary Melanoma - Note the correctopia

Iridociliary melanoma
Iridociliary melanoma - In this case the tumor has filled one sector of the anterior chamber and touches the corneal endothelium.

Iris Cyst
Iris Cyst - Transstromal Iris Cyst with compression of the iris stroma anterior to the tumor (arrow). High frequency ultrasound shows echolucency within the tumor.

Iris ectropion uveae
Iris ectropion uveae - Induced by an iridociliary melanoma.

Diffuse iris melanoma
Diffuse iris melanoma - This eye was lost to secondary glaucoma.

Iris Melanocytoma
Iris Melanocytoma - Note its cobblestone surface and slight correctopia.

Iris Melanoma
Iris Melanoma - This tumor was characterized by pigment dispersion on to the iris stroma and correctopia.

Iris Melanoma

Iris Melanoma
Iris Melanoma - Gonioscopy reveals the pigmented iris tumor arising from the iris stroma. It is seen to extend from the ciliary body band into the pupil.

Iris Melanoma
Iris Melanoma - A surgical iridectomy completely removes the tumor but leaves an enlarged pupillary aperture.

Iris melanoma
Iris melanoma - Note the pigment liberated from the tumor onto the adjacent iris stroma.

Iris Melanoma
Iris Melanoma fills the angle and causes correctopia

Infiltrative Intraocular Tumors

Posted on May 9, 2016

A subfoveal collection of leukemic cells surrounded by hemorrhage.
A subfoveal collection of leukemic cells surrounded by hemorrhage. Though solitary, this infiltrative tumor is rather typical in appearance.

Choroidal infiltration multiple myeloma
Choroidal infiltration multiple myeloma - Note the associated widening of the optic nerve shadow and papilledema

Choroidal lymphoma
Choroidal lymphoma - Fundus photograph

Choroidal Lymphoma
Choroidal Lymphoma - B-scan ultrasound

Leukemia
Leukemia - Anterior uveal infiltration as seen by slit-lamp (narrow beam) shows narrow angles

Leukemia infiltrated iris is thickened

Leukemic hypopyon with hyphema
Leukemic hypopyon with hyphema (atraumatic) in a 6 year old child

Fluorescein/ICG Angiography

Posted on May 9, 2016

Choroidal Hemangioma
Left: Fluorescein angiography reveals the coarse vascular pattern that is commonly found on the tumor surface. Right: This pattern disappears in the late phases and is replaced by nonspecific diffuse hyperfluorescence.

Choroidal metastasis - Wilm`s tumor
Choroidal metastasis - Wilm`s tumor - Note irregular tumor filling and no definite tumor vessels.

Choroidal Nevus
Choroidal Nevus - Focal fluorescence documented over the apex of this choroidal nevus during angiography.

Choroidal Nevus
Choroidal Nevus- Note the small exudative retinal detachment along the inferior margin of this suspicious choroidal nevus.

Circumscribed Choroidal Hemangioma
Circumscribed Choroidal Hemangioma - A course vascular pattern is best seen with fluorescein angiography.

Combined hamartoma
Combined hamartoma of the retinal pigment epithelium

Metastatic choroidal tumor
Metastatic choroidal tumor - Note the diffuse fluorescence and lack of well-defined tumor vessels.

Radiation optic neuropathy
Radiation optic neuropathy - Hemorrhagic variant.

Eyelid Tumors

Posted on May 3, 2016

Basal cell carcinoma
Basal cell carcinoma - Right lower eyelid with ectropion and orbital invasion (note the central crater).

Basal Cell Carcinoma
Basal Cell Carcinoma - A recurrent morpheaform basal cell carcinoma before and six months after external beam radiation therapy.

Basal cell carcinoma
Basal cell carcinoma at the medial canthus. Note the pearly margins and central crater.

Capillary Hemangioma of Childhood
Capillary Hemangioma of Childhood - Note the epidermal extension (arrowhead), the red cutaneous coloration and mass effect on the nostril.

Eyelid Melanoma
Eyelid Melanoma - Pagetoid extension on to the eyelid from malignant melanoma of the conjunctiva.

Hutchinson`s Freckle
Hutchinson`s Freckle - Typically treated as a cutaneous malignant melanoma.

Hydrocystoma at the medial canthus
Hydrocystoma at the medial canthus - Care must be taken to remove all cyst elements and to preserve the lacrimal system.

Lympangioma
Lympangioma can involve/invade the eyelids causing bluish discoloration

Lymphangioma of the eyelid
Lymphangioma of the eyelid - A small subcutaneous lymphangiectasia (arrow) of the eyelid extending from a larger orbital lymphangioma.

Malignant melanoma of the eyelid
Malignant melanoma of the eyelid - Note a small diagnostic wedge biopsy was taken prior to excision with large margins.

Nevus of Ota
Nevus of Ota - Note the episcleral (ocular melanosis) and eyelid melanosis.

Pigmented nevus
This well circumscribed pigmented nevus does not occlude the punctum and has not grown.

Sebaceous carcinoma (diffuse)
Sebaceous carcinoma (diffuse) in the upper eyelid - Note the eyelash loss and yellow appearance

Sebaceous carcinoma in the upper eyelid
Sebaceous carcinoma in the upper eyelid - Note the eyelash loss and chalazion-like appearance.

Seborrheic keratosis
Seborrheic keratosis - not the cobblestone surface, lack of inflammation (dermatitis), and stuck-on appearance.

Squamous Carcinoma of the Eyelid
Squamous Carcinoma of the Eyelid - Note lash loss, erythema, crater and desquamation on its surface.

Exenteration After Images

Posted on May 3, 2016

After Orbital Exenteration
After Orbital Exenteration- A Cosmetic Prosthesis is PossibleAfter Orbital Exenteration - A Cosmetic Prosthesis is Possible

Example using the eyelid skin to line the exenterated orbit.

Post-exenteration Prosthesis

Enucleation After-Images

Posted on May 2, 2016

Man with and without glasses

Young woman without glasses

Young woman in glasses

Young woman

Woman with glasses

Ten years later

Slight Ptosis (droopy eye lid)

More than 15 years later
Now more than 15 years after enucleation surgery.

Temporary prosthesis
Most patients can tolerate a temporary prosthesis 5 days after enucleation surgery

Man without glasses

Man with glasses

Almost 10 years after enucleation surgery.

Looking to the right

Lady without glasses

Lady with glasses II

Lady with glasses

Happy with cosmetic result

8 years later
Gentleman happy with his cosmetic result - now 8 years later

Excellent cosmetic result

Enucleation with implant I
Enucleation with implant I - Looking Left

Enucleation with implant I

"superior sulcus deformity"
Sometimes there can be a depression over the eye called a "superior sulcus deformity"

Cytology Slides

Posted on May 2, 2016

Adenoid cystic carcinoma
Adenoid cystic carcinoma - Choroidal biopsy specimen.

Iris Melanocytoma
Iris Melanocytoma - FIT specimen

Iris melanoma
Iris melanoma - FIT specimen

Iris nevus cells
Iris nevus cells - FIT specimen

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