The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Sentinel vessels

Photo by Professor Chua Chung Nen

A 54 year-old woman presented with a one-year history of poor right vision. Examination revealed the presence of dense cataract and dilated episcleral vessels near the nasal limbus. Ultrasound scan revealed a large lesion in anterior part of the posterior segment. The appearance suggested that the dilated episcleral vessels are sentinel vessels. She was referred to the medical team for the detection of any primary neoplasm but the team did not reveal any medical condition of note. At the subsequent ophthalmic consultation, the base of the iris showed the presence of multiple black lesions with dilated iris vessels. The features were suggestive of a choroidal melanoma with anterior chamber extension. The patient was informed of the possible diagnosis and enucleation was proposed.

 

Initial appearance of the right eye with episcleral sentinel vessels.

 

Ultrasound appearance of a mass in the posterior segment.

 

Presence of multiple black lesions at the base of the iris with dilated iris vessels.

 

Black lesions at the base of the iris, dilated iris vessels and episcleral sentinel vessels.

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