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Unusual presentation of a choroidal melanoma
  1. Sunila Jain1 and
  2. Kar Yen Phoong2
  1. 1Ophthalmology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
  2. 2The University of Manchester, Manchester, Manchester, UK
  1. Correspondence to Dr Sunila Jain; sunila.jain{at}


A 49-year-old gentleman presented with a 1-day history of painful deterioration of vision in his right eye. He was lifting heavy weights just before this visual loss. On examination, his vision was perception of light in that eye, with a medically uncontrollable high intraocular pressure and hyphaema almost completely filling his anterior chamber. An ultrasound performed suggested a working diagnosis of a Valsalva related ‘eight ball’ bleed. After an anterior chamber washout, he had another episode of bleeding three days later. A pars plana vitrectomy was performed and the sample obtained was sent off to the laboratory, revealing a choroidal melanoma. Following enucleation, the histology confirmed a large necrotic spindle cell melanoma, with a haemorrhagic background. Fortunately, no liver metastasis was found. Since his diagnosis 3 years ago, he continues to be followed up in an artificial eye clinic and has regular liver scans under the care of his oncologist.

  • anterior chamber
  • eye
  • hyphemas

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  • Contributors SJ is the consultant in charge of this patient and has performed his assessment and initial treatment and is looking after him in the longer term. She planned and wrote the report. KYP is a Medical Student who has helped in putting this case report together. She did the initial research and acquisition of literature and helped write the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.