ABSTRACT

To report a case of tumor invasion into the ipsilateral orbit/optic chiasm and into the contralateral optic nerve. A 51-year-old male who declared removal of his left eye ten years ago elsewhere, attended to our clinic for swelling of the left eyelids and pain. He was ophthalmologically and radiologically evaluated. A hyperpigmented mass was detected at the socket conjunctiva of the patient whose eyelids were swollen and hyperemic. Anterior and posterior segments of the right eye were normal, and the best corrected visual acuity was 10/10. On orbital computed tomography, the left orbit was found to be filled with mass. No intracranial invasion was detected. Exenteration was performed to the patient who had no systemic metastasis. Histopathological examination revealed malignant melanoma. Ten months later, the patient presented with sudden visual loss. Light perception was absent in the right eye. Optic nerve head was pale at fundus examination. No p100 wave was obtained from the right eye with visual evoked potentials. On orbital magnetic resonance imaging, a mass invading the optic chiasm and the right optic nerve was evident. When treated with appropriate methods, choroidal malignant melanoma with no extraocular extension has pretty good prognosis. When performing enucleation in patients with intraocular tumor suspicion, extra care should be spent not to make any unnecessary maneuver leading to extraocular spread. In the presence of extraocular dissemination, exenteration should be performed. (Turk J Ophthalmol 2011; 41: 194-6)