35 yr woman presented with redness and protrusion of RE since 3 months.. examination revealed RE eccentric proptosis, congestion on medial side, vision was 6/24 not improving. USG, Fundus photo and MRI scan attached.. appears like an extraconal mass lesion.. radiologist suggests a choroidal melanoma.. any suggestions regarding DD

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R / out first, Thyroid Ophthalmopathy, involving MR muscle. Then try to seek FNAB from medial canthus.. going Sub-cinjuctival only if Doppler says No Vascular tumor or Meningioma.

To me it is more likely to be cysticercosis..

and one thing I would like to ask.. the other eye also has scleral show..why so?
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I can think of two possibilities 1. Medial rectus cysticercosis 2. Myositis of the the medial rectus (NSOID) Definitely not choroidal melanoma

medial rectus muscle tumor

It's a possibility.. may even be a secondary Infiltration in the muscle from primary tumor elsewhere
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