JAMA Clinical Challenge
Roomasa Channa, MD
Amanda Kiely, MD
Fasika A. Woreta, MD, MPH
A 60-year-old Nigerian man first noted a left eye mass 7 months ago that was progressively enlarging. In the past month, the mass significantly enlarged and became more red and painful, and he can no longer close his eye. He has no other medical history or symptoms. He underwent ocular surface surgery, presumably for a pterygium, on the left eye 1 year ago. This surgery was performed in Nigeria, and he does not know why or what was done. He does not take any medications. He is a construction project manager and does not smoke, drink alcohol, or use illicit drugs. His best-corrected visual acuity was 20/20 in the right eye and 20/25 in the left. His pupils were round and reactive with no afferent pupillary defect. His intraocular pressure was 12 mm Hg in the right eye and 13 mm Hg in the left. Extraocular movements were normal in both eyes. Slit lamp examination of the anterior segment of the right eye was unrevealing. The figure shows the left eye. The anterior chamber, iris, and lens of the left eye were normal. Dilated fundus examination of both eyes was unremarkable.
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Author Affiliations: Drs Channa (firstname.lastname@example.org), Kiely, and Woreta are affiliated with the Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland .