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Case 27


Patient Presentation: A 30-year-old man was referred to a neuro-ophthalmology clinic for assessment of an optic nerve lesion in his right eye. This lesion was found by his optometrist incidentally during a regular eye examination. He was asymptomatic, including no recent vision changes, flashes, floaters or visual field deficit. The patient denied any past medical or ocular history. On examination, visual acuity was 20/20 OD and 20/20 OS, IOP was 18 OD and 17 OS, and there was no RAPD. Anterior segment examination was unremarkable. Fundus photographs were taken and are shown below:


A 5-line OCT image with enhanced depth imaging was taken over this lesion and is shown below:


Question 1: What is the main finding in the OCT above?

Question 2: Based on the exam findings and OCT imaging, what is the most likely diagnosis?

Question 3: What diagnostic test is important to obtain in the monitoring of melanocytomas?

Our patient underwent 24-2 Humphrey Visual Field testing, which was normal OU. He is being followed every 6 months with fundus photography and visual field testing.


Learning Objectives:

  1. Understand the typical OCT features in optic disc melanocytoma

  2. Differentiate melanocytoma from alternative retinal pigmented lesions

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