Malignant Melanoma, Amaurosis, and the Quiet Eye

The reported incidence of unsuspected choroidal, malignant melanomas in blind eyes with opaque media is 4%.¹ The associated findings of unilateral glaucoma, pain and a history of visual difficulties of six months or longer in a Caucasian over the age of 40 support the suspicion of intraocular malignancy.^1,2 These valuable facts and figures have been extracted from a review of eyes in pathology laboratories. In many of the cases there was undoubtedly a previous history of documented eye disease or injury, which made the presence of an intraocular malignancy extremely unlikely. When there is no previous history of eye disease or injury in such an eye, the incidence of unrecognized intraocular malignancy is probably much higher than the reported 4%.

The clinical picture of a blind, normotensive, quiet, white eye with opaque media and a long history of visual difficulty may present a perplexing diagnostic problem. However, with