Images in Clinical Medicine
Traumatic Bleb
N Engl J Med 2009; 361:e2July 9, 2009
- Article
A 38-year-old man was referred for evaluation of a large, pigmented lesion in the left eye for possible uveal melanoma. The patient reported that the growth had developed during the previous several months. Ocular examination revealed an elevated, dark-brown lesion adjacent to the limbus between 9 and 11 o'clock, measuring 8 mm by 4 mm (Panels A and B). The best corrected visual acuity was 20/25 in each eye. Contact ultrasonographic biomicroscopy revealed a cystic structure with communication to the vitreous cavity, prompting the diagnosis of a uveal bleb rather than melanoma. On further focused questioning, the patient reported having injured his eye 10 years earlier, at which time he had not sought medical care. We hypothesized that the scleral wall had been damaged, which had led to the development of the uveal bleb. The patient had recently had a severe episode of vomiting, which might have resulted in an increase in the size of the lesion. The patient was observed for several months, during which time the lesion was stable. The patient was lost to follow-up after 9 months.
Demetrios Vavvas, M.D., Ph.D.
Katarzyna Brodowska, M.D.
Massachusetts Eye and Ear Infirmary, Boston, MA 02114
dvavvas@partners.org
