Panophthalmitis: The Great Masquerader!

A 60-year-old female presented with complaints of sudden painful diminution of vision in the left eye over 5-day duration. Examination revealed proptosis of the left eye with neovascularization of the iris and seclusio pupillae, and fundus could not be visualized. SPECT CT showed a focal area of increased tracer uptake in the anterior and superolateral aspect of the choroid in the left eye, and hence enucleation was performed considering the diagnosis to be melanoma. Histopathological examination revealed it to be panophthalmitis with dense neovascularization of the choroid and ciliary body with no evidence of tumor. An 8-year-old male child born presented with leukocoria of the right eye. There was corneal haze with proptosis of the right eye. CT scan was done to rule out retinoblastoma. CT scan revealed irregular thickening of the right globe with heterogeneous uveoscleral enhancement. The vitreous showed irregular hyperdense thickening with multiple calcifications, indicating it to be a malignancy. The right eye was enucleated, and its histopathology examination revealed panophthalmitis with intraocular ossification. The right globe revealed no evidence of malignancy. Conclusion: Painful blind eye is a major therapeutic dilemma for an ophthalmologist. Radiological findings of irregular thickening of the sclera, vitreous with calcifications, and optic nerve thickening are highly suggestive of intraocular tumors. We wish to emphasize that inflammatory pathologies of the eye can masquerade as malignancies, and we also highlight the limitations of the state-of-the-art radiological equipment in the absence of the view of the fundus.