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Life-threatening cause of a painful red eye

Published:September 18, 2022DOI:https://doi.org/10.1016/j.jcjo.2022.08.010
      A 54-year-old male was referred following an acute episode of severe ocular pain, swelling, and redness of the left eye treated as scleritis with topical corticosteroids. Fundus examination revealed a choroidal melanoma (Fig. 1A, arrow) with central excavation on ultrasonography (Fig. 1B, arrow) suggestive of focal tumour necrosis and responsible for the pain. Optical coherence tomography demonstrated chronic retinal detachment with loss of photoreceptors and an excavated choroid mass (Fig. 1C, asterisk). These features were consistent with choroidal melanoma necrosis, a rare cause for pain and redness of the eye occurring in <1% of eyes with uveal melanoma. Full evaluation, including dilated fundus examination, is warranted in all patients with ocular pain.
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