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Photo courtesy of: Carol L. Shields, M.D. Used with permission. Not to be reproduced.

A 61-year-old white male presented with a referral diagnosis of iris nevus left eye. He had a history of Basal cell carcinoma on his face, nearly five years back. On examination, his best corrected visual acuity was 20/25 in both eyes. Anterior segment examination in right eye revealed a pigmented mass as shown above. Intraocular pressure (IOP) was 22-24 mmHg in both eyes with applanation tonometry. Gonioscopy shows open angles in both eyes and no angle involvement by the pigmental lesion in the right eye. Transillumination showed shadow in the corresponding area. Left eye was within normal limits. Anterior segment and fundus examination in right eye revealed no abnormality.

1.	The most likely clinical diagnosis is:
	a. iris nevus b. iris melanocytoma c. basal cell carcinoma (BCC) metastasis d. iris melanoma with secondary glaucoma e. none of the above
2.	Risk factors if the above lesion is malignant:
	a. pigment dusting b. dilated episcleral vessel c. dark shadow on transillumination d. none of the above e. all of the above
3.	How would you manage this patient?
	a. observation and 6 month follow up b. partial lamellar sclerouveectomy (PLSU) c. plaque radiotherapy d. enucleation e. none of the above

For answers to the above, click here on or after April 8, 2008.