A 65-year-old white male with occasional photopsias is referred from an outside ophthalmologist for a pigmented lesion on his eye. This patient has an extensive cardiac history and a smoking history of 30 packs of cigarettes a year. Vision, intraocular pressure, pupils and anterior segment exam are normal for both eyes. Dilated fundus exam of the right eye is normal; the left eye is shown in the photos here. B-scan ultrasound of the lesion revealed a solid lesion 20x17x8.1 mm with low internal reflectivity and no signs of extrascleral extension.

Thoughts? Please leave a comment...