Necrotic choroidal melanoma with scleritis and choroidal effusion

PURPOSE: To report a case of a choroidal melanoma that presented with painful scleritis and choroidal effusion. METHODS: Interventional case report with cytopathologic correlation. RESULTS: A 78-year-old otherwise healthy woman presented with sudden, severe painful ocular inflammation and marked injection of the right eye over a 3-day period, consistent with scleritis. Upon referral, 360 degrees of scleral and conjunctival injection and peripheral choroidal effusion were found. In addition, a solid hemorrhagic, choroidal mass was evident, suspicious for melanoma. Fine needle aspiration biopsy of the choroidal mass confirmed necrotic melanoma. The melanoma was treated with iodine 125 plaque radiotherapy, and during surgery, the temporal sclera was markedly edematous and the orbital tissue was fibrotic, presumed related to inflammation. Two months after radiotherapy, the scleritis and choroidal effusion had resolved. CONCLUSION: Uveal effusion can rarely occur with uveal melanoma, particularly when the tumor is necrotic.