This 62YO female with type 2 diabetes was referred to us for diabetic retinopathy screening. Vision was 20/40 OD.
Color photography shows moderate non-proliferative diabetic retinopathy with nasal lipid exudation. The inferior portion of the optic disc has a black discoloration deep to the vessels. OCT scanning through this lesion shows a dome-shaped hyperreflective mass with posterior shadowing.
Learning Points:
Melanocytomas are benign melanocytic tumors intrinsic to the optic nerve. They are intensely pigmented with feathery margins, sometimes spreading into the adjacent retina and choroid. A retinal component, as seen in our patient, is found in about 30% of cases (Shields et al, Ophthalmology 2004;111:1739-1746). Although they may enlarge over time, malignant transformation is rare. Spontaneous necrosis may present with a similar appearance to vitreous seeding from melanoma. Vision and visual field loss can rarely occur from compressive optic neuropathy.
