Hidden peril: Large ciliary body melanoma imitating cataract in a cardiac patient

Ciliary body melanoma is a rare and aggressive ocular tumor that often presents with nonspecific symptoms, leading to delayed diagnosis. This report presents the case of a 43-year-old male with a history of ischemic heart disease who presented with diminished vision in the left eye, initially attributed to a cataract. Despite prior evaluation, no sign of malignancy was detected, and the patient was advised to proceed with cataract surgery. The patient visited our center for a second opinion, where a comprehensive evaluation identified a large ciliary body melanoma extending into the anterior chamber. Management was challenging due to the patient's cardiac condition, as anticoagulant therapy could not be discontinued. Enucleation was performed to mitigate the high risk of hematogenous metastasis associated with the tumor's rich vasculature, ciliary body contraction, and potential extension through emissary canals. Histopathology confirmed the diagnosis of spindle cell melanoma. This case highlights the diagnostic complexities of ciliary body melanoma, which can masquerade as a common condition like cataract, emphasizing the need for vigilance in atypical presentations and the importance of thorough evaluation to avoid misdiagnosis. It also underscores the challenges in managing such tumors in patients with significant systemic comorbidities, requiring a multidisciplinary approach for optimal outcomes.