Dr.Anju Kuriakose
A 62 year old gentleman presented with pain and decreased vision in his left eye. On examination, anterior chamber was completely obliterated with mid dilated fixed pupil and no red reflex. Intraocular pressure( IOP) was 81.7 mmHg. The fellow eye was completely normal other than early cortical cataract with IOP of 15mmHg. Provisional diagnosis of secondary angle closure glaucoma was made and patient was started on anti glaucoma medications. Ultrasound B scan revealed complete retinal detachment with subretinal fluid and a plaque, further evaluation was suguested. MRI orbit revealed a 4mm soft tissue lesion extending onto posterior and lateral wall of left eyeball suggestive of melanoma. In view of painful blind eye and uncontrolled IOP, patient was taken up for enucleation of left eye. Hispathological examination confirmed the diagnosis of choroidal melanoma. Any unusual case of angle closure glaucoma should be investigated throughly for secondary causes.
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