To the Editor In response to the article by Koch et al titled “Extraocular Extension of a Benign Ciliary Body Nevus,”1 I would like to note that the slitlamp photograph as well as the ultrasound biomicroscopic image appear identical to the pigmented elevation often seen in Axenfeld nerve loops.2 The location overlying the ciliary body (approximately 3 mm posterior to the limbus), where a long posterior ciliary artery is seen to traverse the sclera in an emissary channel, is classic for this. These nerve loops often incorporate uveal pigment and normal uveal melanocytes. I would like to caution clinicians from the routine biopsy of pigmented lesions in this location unless the clinical history and/or imaging warrant it.
Burris CKH. Axenfeld Loop vs Extrasclerally Extending Ciliary Body Tumor. JAMA Ophthalmol. 2016;134(7):846. doi:10.1001/jamaophthalmol.2016.1022
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