10-year-old girl presents for annual follow-up. She reports that she recently failed a school screening
February 21, 2005
Chief Complaint: 10-year-old girl presents for annual follow-up. She reports that she recently failed a school screening.
History of Present Illness: However, the patient offers no complaints herself.
PMH: healthy. FH: non-contributory.POH: Limbal Dermoid OS, Retinal Lesion OD.
- Best corrected visual acuities: 20/40 OD, 20/20 OS
- Stereo Vision: normal
- Pupils: normal, no RAPD
- VF: full to CF OU
- EOM: normal
- IOP: normal OU
- SLE: normal
- DFE: see below
|OD - age 5. Large area of sub-retinal fluid.||OD - age 7. Deep area of calcification enlarges.|
|FFA OD - early||FFA OD - mid|
|A-Scan OD||B-Scan OD|
|A-Scan echography demonstrates sound attenuation posterior to the lesion (i.e. downward sloping after the second signal peak).||B-Scan echography demonstrates shadowing posterior to the highly dense lesion (i.e. dense plaque with absent signal behind the lesion).|
This is an osseous choristoma of the choroid. There is no known treatment. There is a predilection for women, and it is typically found in the second or third decade of life. Choroidal osteomas may be bilateral in 25% of cases. Growth is seen in 40% of cases with long-term follow-up. These lesions may be associated with choroidal neovascular membranes (CNVM), sub-retinal fluid, and sub-retinal hemorrhages.
80% of patients have 20/30 vision or better at presentation. Visual loss may be gradual or acute due to RPE degeneration or CNVM. Dr. Gass estimates that up to 33% of eyes with choroidal osteoma may develop CNVM.
Fluorescein Angiography: Early, patchy hyperfluorescence with intense late staining.
Echography : Densely echogenic (extremely high internal reflectivity of bone), persists at low sensitivities. Marked "Shadowing," or sound attenuation posterior to lesion. "Void" appears behind lesion.
Histology : Mature bone with interconnecting marrow spaces. Lesion is sharply demarcated form choroid.
Diagnosis: Choroidal Osteomas
- Amelanotic Choroidal Melanoma
- Amelanotic Choroidal Nevus
- Choroidal Hemangioma
- Metastatic Carcinoma
- Organized Submacular Hemorrhage
- Cicatricial Macular Degeneration
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- Traboulsi, E.I., et al., Posterior scleral choristoma in the organoid nevus syndrome (linear nevus sebaceus of Jadassohn). Ophthalmology, 1999. 106(11):2126-30.
Suggested citation format: Bianchi GM, Keech RV, Olson R: Choroidal Osteoma: 10-year-old girl presents for annual follow-up. She reports that she recently failed a school screening. February 21, 2005; Available from: http://www.EyeRounds.org/cases/case12.htm.