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JAMA Ophthalmology Clinical Challenge
December 2014

Peculiar Protuberance

Author Affiliations
  • 1Department of Ophthalmology, University of California, San Francisco
JAMA Ophthalmol. 2014;132(12):1483-1484. doi:10.1001/jamaophthalmol.2014.3935

A 47-year-old woman complained of a lesion under her left lower eyelid. The patient noticed the lesion when looking in a mirror 3 years prior to presentation. The patient has had no visual changes or other symptoms but thinks the lesion may have grown slightly since first detected. The patient wears spectacles for myopia but has no other ocular history and denies a history of trauma. Her medical history is unremarkable, and her review of systems was negative, except for occasional back pain for which she takes tramadol hydrochloride orally. On examination, her corrected acuity was 20/20 OD and 20/25+ OS. The results of pupil, motility, and confrontational visual field examinations were normal. The intraocular pressure was 17 mm Hg OD and 18 mm Hg OS. The patient’s manifest refraction was −14.50 + 2.50 × 089 diopters OD and −16.00 + 4.00 × 077 diopters OS. The results of an anterior segment examination are that both the right eye and the left eye, except for the lesion identified (Figure 1), are normal. The results of a dilated fundoscopic examination are that the right eye is normal but that the left eye reveals a small area of shallow retinal detachment with associated retinal pigment epithelial pigment changes in the inferotemporal periphery.

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