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Shraddha Raj Shrivastava, Akansha Sharma and Manish Nagpal
This 48YO female presented with 6 months of mild blurred vision in her right eye. She was diagnosed elsewhere with a choroidal granuloma and referred to us for further evaluation. Vision was 20/20 OD and 20/25 in her normal OS.
Pseudocolor SLO imaging shows a well-demarcated, round, dome-shaped orange-red choroidal lesion centered in the infotemporal macula. OCT shows a smooth, dome-shaped, elevated choroidal lesion with a gently sloping anterior contour. The overlying retina appears normal. The lesion shows early autofluorescence with late leakage on fluorescein angiography and is somewhat better imaged with indocyanine green angiography (ICGA), although late-phase ICGA showing tumor washout was not possible due to patient vomiting and allergic hives. B-scan ultrasonography shows a smoothly thickened choroidal lesion with high internal reflectivity and homogeneous internal acoustic characteristics.
We recommended observation due to the lack of symptoms or exudation.
Learning Points:
Choroidal hemangioma is an uncommon benign hamartomatous disorder that presents as either a circumscribed, orange-red, round choroidal lesion (as in our patient), which is almost always isolated and nonsyndromic, or a diffuse form, which is usually part of Sturge-Weber syndrome. Although there is no malignant potential, it can cause vision loss from exudation leading to subretinal and intraretinal fluid, which is best treated with photodynamic therapy (see Yang et al., Surv Ophthalmology 2025;70:389-400).
Graefes Arch Clin Exp Ophthalmol. 2026 Sep;264(9):2871-2876. doi: 10.1007/s00417-026-07229-w.
Extraocular silicone oil deposition in ocular adnexa (conjunctiva, eyelid, orbit) — Retrospective, 25 clinicopathologic specimens
Purpose: To characterize the clinicopathologic features of extraocular silicone oil (SO) migration in the ocular adnexae, including the conjunctiva, eyelid, and orbit (CEO).
Methods: Retrospective, single-institution case series. The Florida Lions Ocular Pathology Laboratory database at the Bascom Palmer Eye Institute was searched for surgical specimens diagnosed with “silicone oil” involving the ocular adnexae from 1997 to 2023. Clinical and histopathologic features were reviewed. All specimens were stained with hematoxylin-eosin, and immunohistochemical stains for histiocytes CD68 (M1, pro-inflammatory) and CD163 (M2, anti-inflammatory).
Results: 25 specimens met inclusion criteria. Affected sites included the conjunctiva (76%), orbit (12%), eyelid (8%), and Tenon’s capsule (4%). Histopathology revealed clear dropout spaces consistent with SO surrounded by histiocytes in all cases. CD68 and CD163 both highlighted histiocytes, with CD163 demonstrating significantly higher immunohistochemical staining (p < 0.0001). The average time from SO placement to presentation was 451.1 days (Range: 14 − 1,220 days). SO migration was clinically suspected in 17 cases, presenting with conjunctival injection, irritation, cysts, or eyelid swelling. Imaging (anterior segment OCT, CT) aided diagnosis.
Conclusion: Diagnosis of silicone oil migration in the ocular adnexae is important to avoid misdiagnosis. The presence of M2 histiocytes (anti-inflammatory) is consistent with the high immunotolerance of these lesions.
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