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A Transilluminating Scleral Lesion

A Transilluminating Scleral Lesion A 63-year-old white woman in good health was referred for evaluation after an optometrist noticed a darkly pigmented scleral lesion in the right eye. Visual acuities were 1/60 OD and 6/9 OS (OD+1.25DS; OS+2.25/−3.50/020). She was completely asymptomatic. She did not have rheumatoid disease. Examination revealed exotropia of the right eye along with a smooth, elevated grayish lesion (Figure 1). When the slitlamp was shone through the pupil, the nodule transilluminated (Figure 2). Dilated funduscopy was unremarkable. On direct inquiry, she revealed that she had undergone squint surgery as a child and had been detained in the hospital for a month while undergoing intensive topical antibiotic treatment. Figure 1. View LargeDownload Clinical photograph showing a smooth, elevated grayish nodule in the region of the lateral rectus insertion. Figure 2. View LargeDownload Clinical photograph showing the transillumination of the nodule seen in Figure 1. Comment There are many potential diagnoses of a grayish scleral lesion that include serious conditions such as uveal melanoma with extrascleral extension. Iatrogenic perforation of the sclera can occasionally leave permanent subconjunctival uveal pigment, particularly over the lateral rectus muscle following strabismus surgery.1 In the absence of systemic disease, the observation that this lesion transilluminates excludes a serious abnormality. We believe that this staphyloma is probably related to the strabismus surgery she had as a child, which may have been complicated by the abscess of a stitch. Correspondence: Dr Mollan, Ophthalmology, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, West Midlands B187QH, England (soozmollan@doctors.org.uk). Financial Disclosure: None reported. References 1. Dunlap EA Muscle surgery. In:Duane TDJaeger EAeds. Clinical Ophthalmology. 5 Philadelphia, Pa Harper & Row1983;1- 28Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

A Transilluminating Scleral Lesion

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A Transilluminating Scleral Lesion

Abstract

A 63-year-old white woman in good health was referred for evaluation after an optometrist noticed a darkly pigmented scleral lesion in the right eye. Visual acuities were 1/60 OD and 6/9 OS (OD+1.25DS; OS+2.25/−3.50/020). She was completely asymptomatic. She did not have rheumatoid disease. Examination revealed exotropia of the right eye along with a smooth, elevated grayish lesion (Figure 1). When the slitlamp was shone through the pupil, the nodule transilluminated (Figure 2). Dilated...
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.124.10.1504
Publisher site
See Article on Publisher Site

Abstract

A 63-year-old white woman in good health was referred for evaluation after an optometrist noticed a darkly pigmented scleral lesion in the right eye. Visual acuities were 1/60 OD and 6/9 OS (OD+1.25DS; OS+2.25/−3.50/020). She was completely asymptomatic. She did not have rheumatoid disease. Examination revealed exotropia of the right eye along with a smooth, elevated grayish lesion (Figure 1). When the slitlamp was shone through the pupil, the nodule transilluminated (Figure 2). Dilated funduscopy was unremarkable. On direct inquiry, she revealed that she had undergone squint surgery as a child and had been detained in the hospital for a month while undergoing intensive topical antibiotic treatment. Figure 1. View LargeDownload Clinical photograph showing a smooth, elevated grayish nodule in the region of the lateral rectus insertion. Figure 2. View LargeDownload Clinical photograph showing the transillumination of the nodule seen in Figure 1. Comment There are many potential diagnoses of a grayish scleral lesion that include serious conditions such as uveal melanoma with extrascleral extension. Iatrogenic perforation of the sclera can occasionally leave permanent subconjunctival uveal pigment, particularly over the lateral rectus muscle following strabismus surgery.1 In the absence of systemic disease, the observation that this lesion transilluminates excludes a serious abnormality. We believe that this staphyloma is probably related to the strabismus surgery she had as a child, which may have been complicated by the abscess of a stitch. Correspondence: Dr Mollan, Ophthalmology, Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham, West Midlands B187QH, England (soozmollan@doctors.org.uk). Financial Disclosure: None reported. References 1. Dunlap EA Muscle surgery. In:Duane TDJaeger EAeds. Clinical Ophthalmology. 5 Philadelphia, Pa Harper & Row1983;1- 28Google Scholar

Journal

Archives of Ophthalmology – American Medical Association

Published: Oct 1, 2006

Keywords: sclera

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