Title : Eyes of stone: Bilateral choroidal osteoma presenting with enophthalmos in a young myopic female
Abstract:
Introduction: Choroidal osteoma is a rare, benign ossifying tumor characterized by mature bone formation within the choroid. It typically affects young women, is usually unilateral, and may lead to significant visual morbidity due to complications such as choroidal neovascularization and subretinal fluid. Multimodal imaging plays a key role in differentiating this entity from other choroidal lesions. Bilateral involvement is uncommon and carries important diagnostic implications.
Case Presentation: We report the case of a 33-year-old woman with high myopia since childhood who presented to the Ophthalmology outpatient department, with a 10-day history of a “sunken” appearance of the right eye and intermittent ocular discomfort. Best-corrected visual acuity measured 6/9 in the right eye and 6/12 in the left eye. Anterior segment examination and intraocular pressures were unremarkable. Dilated fundus examination revealed well-defined yellow-white lesions involving the optic disc and macular regions in both eyes, with overlying retinal pigment epithelial atrophy. Macular and RNFL OCT scans of both eyes appeared normal, excluding alternative retinal or optic nerve pathology. B-scan ultrasonography demonstrated dense, highly reflective calcific deposits with posterior acoustic shadowing in each eye, confirming bilateral choroidal osteoma. No evidence of choroidal neovascularization or subretinal fluid was detected.
Discussion: This case highlights an uncommon bilateral presentation of choroidal osteoma in a young myopic woman. Despite the extensive choroidal involvement, structural retinal integrity on OCT was preserved, aligning with typical imaging patterns of calcified lesions. The absence of CNV or subretinal fluid supported conservative management. Early recognition and differentiation from amelanotic melanoma, hemangioma, and sclerochoroidal calcification are critical to avoid unnecessary interventions.
Conclusion: The patient was counseled and placed on close monitoring with three-month follow-up and education regarding symptoms of potential CNV. This case underscores the value of multimodal imaging in diagnosing choroidal osteoma and emphasizes the importance of individualized surveillance in patients without complications.
