Malignancy in the blind painful eye--report of two cases and literature review

Abstract

Background: Few cases of malignant tumors arising in a blind painful eye have previously been described. We described two cases of a blind painful eye containing an unsuspected tumor, which were enucleated to relieve the pain.

Case presentations: Case 1: A 57 year-old Caucasian man presented with recurrent orbital cellulitis and endophthalmitis in the left eye (OS). The OS was blind and painful and an enucleation was performed showing a uveal melanoma by histopathological exam. Case 2: A 54 year-old Caucasian man with previous history of a rhegmatogenous retinal detachment in his left eye presented a blind painful eye. Enucleation was performed revealing a well-differentiated B-cell lymphoma of uveal tract with extra ocular extension.

Conclusion: In the management of a blind painful eye, it is extremely important to rule out an intraocular malignancy particularly in those patients who have not been followed by an ophthalmologist.

Figure 1

A: Gross examination discloses a pupil-optic nerve section presenting a pigmented mass on the choroid with extra-ocular extension. B: Photomicrograph of immunohistochemistry stained with HMB-45 showing strong reaction in almost all cells. The tumor is composed by epithelioid cells with large nuclei and conspicuous nucleoli. (Original magnification 200×). C: Gross examination of pupil-optic nerve section showing a whitish mass committing all uveal tract with extra-ocular extension. D: Haematoxylin and Eosin (H&E) preparation showing tumor in the uveal tract with extra-ocular extension.