Melanocytoma inducing compressive optic neuropathy: the ocular morbidity potential of an otherwise invariably benign lesion.

PURPOSE: The purpose of this article is to document a case of melanocytoma of the optic nerve head inducing compressive optic neuropathy; to provide a summarized clinical review; and to reflect on the potential ocular morbidity aspects of this relatively benign insult.
METHODS: We present a case report of a 32-year-old Hispanic woman with constant esotropia, inert tractional Toxacara granuloma in the right eye, and a jet-black lesion engulfing the left eye optic nerve head, with accompanying disk edema.
RESULTS: A diagnosis of melanocytoma of the optic nerve with secondary compressive optic neuropathy was made on the basis of the clinical presentation. Patient education and quarterly follow-up visits to monitor the lesion were the recommended management.
CONCLUSION: Although optic nerve head melanocytoma can be considered benign, it has the underlying potential to promote ocular morbidity. Our case report highlights the potential impact of melanocytoma on optic nerve head anatomy. The potential for even subtle changes in the visual fields from this condition becomes significant in a monocular patient. This is exemplified in this case, by the presence of a co-existing Toxacara granuloma and related amblyopia in the contralateral eye.