3. CHIEF COMPLAINTS
• Blurring of vision in right eye for 7 days
• Seeing of black spot in right eye for same duration
4. HISTORY OF PRESENT ILLNESS
• According to patients statement he noticed blurring of vision
and floaters in his right eye for 7 days. Onset was sudden,
progressive in nature and not associated with any pain or
redness
• No history of trauma, systemic illness and drugs
5. GENERAL EXAMINATION
• Appearance: Ill looking
• Body built: Average
• Pulse: 74/min
• BP: 120/70 mm of Hg
• Respiratory rate: 14/min
• Temperature: 97⁰F
• Anaemia: Absent
• Jaundice: Absent
• Cyanosis: Absent
• Oedema: Absent
7. OCULAR EXAMINATION
VA RE LE
Unaided 6/18P 6/6P
Aided NI (-1.0/-0.50/180⁰) 6/6 (-0.50)
Near N10 N6
8. OCULAR EXAMINATION
RE LE
Eye lid Normal Normal
Conjunctiva Normal Normal
Cornea Clear Clear
A/C Normal Normal
Pupil RRR RRR
Lens Clear Clear
Anterior Vitreous Cells Normal
IOP 12 mm of Hg 12 mm of Hg
9. FUNDUS EXAMINATION
RE LE
Media Clear Clear
Optic disc Pigmented dark
elevated lesion over
the disc
Size , Shape & Color
normal. CD – 04 : 1
Macula Exudates
resembling Star
NAD
19. DISCUSSION
KEY FACTS :
• Rare unilateral heavily pigmented hamartoma,
seen most frequently at the optic nerve head
but may involve the adjacent retina and
choroid
• Benign tumor, very rarely malignant ( 1-2%)
• Congenital and non-hereditary lesion
• No sexual predilection
20. HISTOPATHOLOGY :
• Histopathologically composed of highly
pigmented round cells with cytoplasmic
melanosomes
• Cells are of low nuclear-to-cytoplasmic
ratio
21. DIAGNOSIS :
SYMPTOMS :
• Usually asymptomatic and stable
• However, visual symptoms are associated with exudation
with foveal involvement or other complications
CLINICAL FINDINGS :
• Dark brown or black, flat or slightly elevated lesion with
feathery edges
• RAPD may be present, even if VA is good
22. INVESTIGATIONS :
COLOUR FUNDUS PHOTOGRAPHY : Documentation of lesion
to monitor for growth
FLUORESCEIN ANGIOGRAPHY : Hypofluorescent , which
differentiates melanocytoma from malignant melanoma
23. B-SCAN : A dome-shaped appearance is a frequent feature in
melanocytoma, and its high internal echogenicity indicates a benign lesion
OPTICAL COHERENCE TOMOGRAPHY (OCT) : Nodular elevation with dense
posterior shadowing
24. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY (OCT-A) :
• To visualize capillaries on the tumor surface
• To determine the tumor's depth
• Quantification of the microvascular flow rate
• Identification of progression
VISUAL FIELD :
To evaluate for defects secondary to compression of optic disc
25. SYSTEMIC ASSOCIATIONS :
• Usually isolated condition
• But some studies suggest association with
neurofibromatosis type 2, basal cell carcinoma,
vitiligo & hypertension
27. TREATMENT :
• Observation
• Clinical and imaging follow-up should be
performed annually
PROGNOSIS :
Vast majority of cases remains stable and do not lead to visual
impairment
28. TAKE HOME MESSAGE
• Optic disk melanocytoma is a benign neoplasm
• Seldom exhibits malignant transformation
• Nevertheless, it can show growth and several
complications
• Annual follow up with CFP & OCT should be
considered
29. REFERENCES
1. Kanski's clinical ophthalmology : a systematic approach. [Brad Bowling; Jack
J Kanski]
2. American Academy of Ophthalmology
3. Rapid Diagnosis in Ophthalmology Series: Retina
4. EyeWiki
