Inadvertent evisceration of eyes containing uveal melanoma.
OBJECTIVE
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.


METHODS
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.
Eagle
Ralph C
RC
Department of Pathology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. reagle@willseye.org
Grossniklaus
Hans E
HE
Syed
Nasreen
N
Hogan
R Nick
RN
Lloyd
William C
WC
Folberg
Robert
R
D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000209:etiology / Q000601:surgery; D003951:Diagnostic Errors; D009877:Endophthalmitis / Q000175:diagnosis*; D017234:Eye Evisceration; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D009336:Necrosis; D009915:Orbit / Q000473:pathology; D054517:Orbital Cellulitis / Q000175:diagnosis*; D016727:Orbital Pseudotumor / Q000175:diagnosis*; D010146:Pain / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014604:Uveal Neoplasms / Q000175:diagnosis*