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Diagnosing tumours

As mentioned in all textbooks, the diagnostic process requires:

  • ophthalmic history taking
  • systemic, past, and family history
  • full examination of both eyes, with pupillary dilatation and, in selected cases, gonioscopy

 

Intraocular tumours

To diagnose an intraocular tumour it is necessary to assess:

  • the layer in which the tumour originates (e.g., choroid, RPE, retina)
  • the colour of the tumour itself (as opposed to secondary changes)
  • the margins
  • the secondary effects on adjacent tumours (e.g., the RPE)

 

Online atlas of ocular tumours

It is difficult to for general practitioners to detect a rare tumour, especially one they may never have heard of. Time is usually too short for them to refer to a textbook, even if a book on ocular tumours is handy at the time. For these reasons, an online atlas of ocular tumours has been developed. The intention of this atlas is to enable practitioners to identify tumours by their appearance, even tumours whose existence they may not be aware of. 

 

This online atlas has an aid to differentiating choroidal naevus from melanoma and gives a tentative guide as to whether to observe or refer the patient for a second opinion.

 

Conjunctival tumours

Although it is easy to biopsy a conjunctival tumour, this can cause widespread conjunctival seeding of a conjunctival melanoma, significantly complicating treatment and worsening the prognosis. In view of the rarity of these tumours, it would seem reasonable to refer such a patient for more expert care. If biopsy is performed, it must be done using a no-touch technique (i.e., not touching the tumour itself with the instruments), not re-using swabs, and using a fresh set of instruments for closure.