Sympathetic Ophthalmia as a Complication of Untreated Choroidal Melanoma

Abstract

We present a rare case of sympathetic ophthalmia in the fellow eye of a 59-year-old Caucasian male diagnosed with untreated malignant choroidal melanoma. Initially identified with a medium-sized choroidal melanoma, the patient declined recommended brachytherapy and did not seek medical attention for two years. Upon returning, he exhibited signs of sympathetic ophthalmia in the contralateral eye. Treatment with corticosteroid-based immunosuppression was initiated. After consenting to treatment for the melanoma, the affected left eye was enucleated, and histopathology confirmed spindle cell choroidal melanoma. This case underscores the uncommon development of sympathetic ophthalmia without prior ocular trauma or surgery, linked to untreated choroidal melanoma.

Keywords: choroidal melanoma; sympathetic ophthalmia; uveal melanoma.

Figure 1

Images showing the left eye of the patient; (A) measurement of the melanoma at the moment of first admission; (B) melanoma at the moment of first admission; (C,D) slit lamp examination of the left eye (OS) in the moment of SO appearance in OD, 2 years after initial tumor diagnosis: complete shallowing of the anterior chamber due to tumor masses in the posterior segment of the eye; (E) ultrasound at the moment of SO appearance shows that left eye is completely filled with tumor masses.

Figure 2

Images showing the right eye; (A) slit lamp examination of the right eye at the moment of SO appearance; (B) ultrasound at the moment of SO appearance shows vitreous opacities and thicker choroid in the right eye; (C,D) fundus photo and autofluorescence of the right eye revealing destructive processes of choroid and retina.