Excerpt from The Medical Counselor, Vol. 6
The choroid coat of the eye is subject to sarcomatous, tubercular, and carcinomatous neoplasms, but the former are by far the most numerous. Sarcoma of the choroid is unilateral as a rule. It originates in the larger blood vessels, is composed of round or spindle cells, and is usually pigmented (melano-sar-coma), although in a small percentage of cases the pigment is absent leuco-sarcoma). The latter develops in the anterior portion of the uveal tract, and at a much earlier age than the melanotic. which is rarely observed under the age of forty. In the choroid it is almost always primary and destroys the eye. Because of its tendency to recur after removal, and to give rise to secondary growths in other parts of the body, it is always malignant, and unless removed very early results in death, soon or late.
Four well-defined stages mark the natural course of the disease.
First, or latent stage. Unless it begins at the macula, vision is disturbed little, if at all, while the tumor is small, and hence it is likely to escape notice. Even during this time, however, if the eye is examined by the ophthalmoscope, more or less detachment of the retina will be observed. As the tumor grows, the detachment enlarges, and the corresponding defect in the visual field increases until the blindness is complete. Up to this time, the aye seems unchanged externally, but after a year or so a sudden increase of tension ushers in the
Second, or inflammatory stage Pain and the other signs of sub-acute glaucoma accompany it, and from this on the suffering is constant, the eye is red. and large veins mark the site of the tumor. As the neoplasm grows larger, the sclerotic bulges and after a time ruptures.
The Third, or extra-ocular stage, now begins, the tumor forming an ever-increasing, irregular, bluish mass outside the globe. The conjunctiva covers it for a time, but it, too, soon gives way, and an offensive discharge and hemorrhages come from the exposed, ulcerating surface of the tumor. With the giving way of the coats of the eyeball, the pain and tension lessen, of course, but the tumor grows all the more rapidly, and if the rupture was within the orbit, the eye is displaced forwards or sidewise, according to the location of the growth. The lymphatics are not involved, but the disease soon spreads to the lids and skin, and extends backwards through the optic foramen and the sphenoidal fissure to the brain.
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