Acute-Onset Blurred Vision With Shallow Anterior Chamber and Suspected Choroidal Mass

Abstract

A healthy 67-year-old man presented to the ocular oncology service with a 3-day history of acute-onset blurred vision and mild tenderness of his left eye. He denied notable ocular history aside from a recently documented elevated intraocular pressure (IOP) of 36 mm Hg OS and shallow anterior chamber (AC). Laser peripheral iridotomy had been performed but failed to deepen the AC. Subsequently, a choroidal mass was discovered, and he was referred for our opinion.On examination, refractive error was +3.00 D OU, and best-corrected visual acuity was 20/25 OD and 20/40 OS. Results of examination in the right eye were unremarkable, and IOP was 17 mm Hg. Examination of the left eye revealed elevated IOP of 26 mm Hg while the patient was taking dorzolamide/timolol. The AC was shallow, and episcleral vessels were congested. Ophthalmoscopic examination and wide-angle scanning laser ophthalmoscopy (Figure 1A) documented a ring-shaped peripheral ciliochoroidal mass accompanied by shallow serous retinal detachment inferiorly. Globe transillumination revealed an undefined mottled choroidal shadow inferiorly. B-scan ultrasonography (Figure 1B) and ultrasound biomicroscopy suggested an echolucent ciliochoroidal elevation without intrinsic vascular pulsations. Magnetic resonance imaging of the orbits confirmed the ring-shaped ciliochoroidal elevation with nonenhancement of the mass. Doppler ultrasonography showed normal flow parameters without evidence of a dural-cavernous fistula. Serous choroidal detachment B Choroidal detachment with folds A Figure 1. A, Wide-angle fundus photograph demonstrating peripheral choroidal elevation, most prominent superotemporally, and numerous choroidal folds. B, B-scan ultrasonography showing extensive choroidal detachment. WHAT WOULD YOU DO NEXT? A. Perform fine-needle aspiration biopsy B. Perform plaque radiotherapy C. Treat with oral corticosteroids D. Proceed with sclerotomies, ie, creation of scleral windows Clinical Review & Education