Choroidal lymphoma masquerading as anterior ischemic optic neuropathy.

PURPOSE: To report a patient with presumed nonarteritic anterior ischemic optic neuropathy (NAION) found on our evaluation to have bilateral uveal lymphoma.

METHODS: The clinical history and physical examination, Humphrey visual field testing, ultrasonography, magnetic resonance imaging (MRI), and fine needle aspiration biopsy specimen of a 60-year-old man with presumed NAION were evaluated.

RESULTS: The patient initially presented with painless blurred vision OD and foreign body sensation OS. Upon examination, he was found to have optic nerve edema OD suspicious for NAION and oral steroids were employed with no improvement. Later, an abnormality in the left eye raised suspicion for choroidal metastasis. By ultrasound, the tumor in the left choroid was acoustically hollow. MRI of the orbits revealed a choroidal infiltrative process OU. Fine needle aspiration biopsy of OS confirmed atypical lymphocytes, predominantly small to intermediate sized, without necrosis. The patient was treated with external beam radiation therapy to both eyes.

CONCLUSIONS: Choroidal lymphoma may present with clinical features of anterior ischemic optic neuropathy or choroidal metastasis.