This is an 81-year-old gentleman who was referred to the University of Iowa glaucoma service for a history of acquired heterochromia, in addition to progressively elevated intraocular pressures. Upon presentation his anterior slit lamp exam showed a deep anterior chamber with 2+ pigmented cell. There was diffuse, velvet-like pigment on the iris in a circumferential fashion and also neovascularization. He had a posterior chamber intraocular lens. Gonioscopy revealed thick pigment overlying the entire iridocorneal angle for 360 degrees, causing his elevated IOP due to obstruction of the trabecular meshwork. Ocular echography revealed a ciliochoroidal lesion measuring 17mm at its base and 6mm in height. He was diagnosed with a ciliochoroidal melanoma leading to ring melanoma which prompted an immediate metastatic work up and subsequent enucleation.
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