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Ralph C. Eagle Jr, MD; Hans E. Grossniklaus, MD; Nasreen Syed, MD; R. Nick Hogan, MD, PhD; William C. Lloyd III, MD; Robert Folberg, MD

Arch Ophthalmol. 2009;127(2):141-145.

Objectives  To report an important complication of ocular evisceration therapy for blind, painful eyes that has been unreported in the literature, and to stress the need for careful preoperative evaluation to exclude occult neoplasms prior to therapy.

Design  Multicenter, retrospective, nonrandomized clinicopathological case series of patients found to have previously unsuspected uveal malignant melanoma during histopathological examination of blind, painful eyes treated by evisceration.

Results  Histopathological examination of evisceration specimens disclosed previously unsuspected uveal melanoma in 7 patients who were treated for blind, painful eyes. Inflammation caused by necrosis of the tumor and other ocular tissues led to misdiagnosis as endophthalmitis, orbital cellulitis, or idiopathic orbital inflammation in several cases. Preoperative imaging was not performed in 3 cases and failed to detect tumors in the remaining 4 cases. Failure of necrotic tumors to enhance contributed to misdiagnosis.

Conclusions  The presence of a malignant intraocular neoplasm should be excluded prior to evisceration of any blind eye or blind, painful eye, particularly with opaque media. Necrosis-related inflammation can confound the clinical diagnosis of occult lesions, as can failure of necrotic tumors to enhance on imaging studies.

Author Affiliations: Department of Pathology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Eagle); Department of Ophthalmology, Emory University, Atlanta, Georgia (Dr Grossniklaus); Departments of Ophthalmology and Pathology, University of Iowa, Iowa City (Dr Syed); University of Texas Southwestern Medical Center, Dallas (Dr Hogan); Department of Ophthalmology, University of Texas Health Science Center, San Antonio (Dr Lloyd); and Department of Pathology, University of Illinois at Chicago (Dr Folberg).

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RELATED LETTERS

Blind Eyes With Occult Malignant Melanoma
Mordechai Rosner
Arch Ophthalmol. 2009;127(9):1227.
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Evisceration After Complete Evaluation an Acceptable Option
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Arch Ophthalmol. 2009;127(9):1227-1228.
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Evisceration of Blind, Painful Eyes With Occult Uveal Melanoma Not a Crime
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Evisceration of Blind, Painful Eyes With Occult Uveal Melanoma Not a Crime—Reply
Ralph C. Eagle, Jr, Hans E. Grossniklaus, Nasreen A. Syed, R. Nick Hogan, William C. Lloyd, III, and Robert Folberg
Arch Ophthalmol. 2009;127(9):1229.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Evisceration of Blind, Painful Eyes With Occult Uveal Melanoma Not a Crime
Sandra M. Brown
Arch Ophthalmol. 2009;127(9):1228-1229.
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Should Evisceration Ever Be Done in a Blind, Painful Eye?
Amy C. Schefler and David H. Abramson
Arch Ophthalmol. 2009;127(2):211-212.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Blind Eyes With Occult Malignant Melanoma
Rosner
Arch Ophthalmol 2009;127:1227-1227.
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Evisceration of Blind, Painful Eyes With Occult Uveal Melanoma Not a Crime
Brown
Arch Ophthalmol 2009;127:1228-1229.
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Evisceration of Blind, Painful Eyes With Occult Uveal Melanoma Not a Crime--Reply
Eagle et al.
Arch Ophthalmol 2009;127:1229-1229.
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Evisceration After Complete Evaluation an Acceptable Option
Perry et al.
Arch Ophthalmol 2009;127:1227-1228.
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Should Evisceration Ever Be Done in a Blind, Painful Eye?
Schefler and Abramson
Arch Ophthalmol 2009;127:211-212.
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