Ullah Tehseena, Gurwood Andrew S, Myers Marc D
Pennsylvania College of Optometry, Philadelphia, 19141, USA.
Optometry. 2009 Oct;80(10):572-8. doi: 10.1016/j.optm.2009.03.017.
Metastatic melanoma to the eye and orbit are rare. Patients at greatest risk often have disseminated metastases in the setting of advanced disease. Because the prognosis for orbital metastatic disease is poor, emphasis must be placed on early detection and prevention. Although cutaneous malignancies include basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma, the majority of cases that result in metastasis, ocular morbidity, and mortality are from sebaceous cell carcinoma and malignant melanoma.
A 72-year-old white woman presented emergently with a chief complaint of sudden, painless vision loss in her left eye of 2 weeks' duration. Her best-corrected visual acuities measured 20/30 in the right eye and 20/400 in the left eye with no improvement on refraction. Her systemic medical history was significant for the diagnosis of a cutaneous malignant melanoma. Examination of the left eye found grade II disc edema with all other posterior pole and peripheral structures intact and unremarkable. Magnetic resonance imaging confirmed the diagnosis of metastatic lesions involving structures of the left orbit ultimately causing reduced visual ability. The patient opted to avoid aggressive care and "hope for the best." Denying significant medical intervention, the woman lived in hospice where she died 6 months later.
The primary care optometric setting, by the way a patient's visual symptoms present or the appearance of fundus abnormalities, can offer the capability of first detection and referral for the discovery of metastatic lesions. Although orbital metastasis is considered a terminal finding in these cases, timely diagnosis enables, while limited, the best options for management.
眼部和眼眶转移性黑色素瘤较为罕见。风险最高的患者通常在晚期疾病背景下出现广泛转移。由于眼眶转移性疾病的预后较差，必须强调早期检测和预防。虽然皮肤恶性肿瘤包括基底细胞癌、鳞状细胞癌、皮脂腺癌和恶性黑色素瘤，但导致转移、眼部发病和死亡的大多数病例来自皮脂腺癌和恶性黑色素瘤。
一名72岁白人女性紧急就诊，主诉左眼突发无痛性视力丧失，持续2周。她的最佳矫正视力右眼为20/30，左眼为20/400，验光后无改善。她的全身病史有皮肤恶性黑色素瘤诊断。左眼检查发现二级视盘水肿，所有其他后极和周边结构完整且无异常。磁共振成像证实了涉及左眼眶结构的转移性病变的诊断，最终导致视力下降。患者选择避免积极治疗，“抱最好的希望”。拒绝重大医疗干预后，这名女性住在临终关怀机构，6个月后去世。
在初级保健验光环境中，通过患者视觉症状的表现或眼底异常的外观，可以提供首次检测和转诊以发现转移性病变的能力。虽然眼眶转移在这些病例中被认为是终末期表现，但及时诊断虽然有限，但能使管理有最佳选择。
