Suprachoroidal and vitreous haemorrhage during a hypertensive crisis as the presenting sign of an unsuspected cilio-choroidal melanoma

A male patient in his early 60s presented with sudden vision loss in his left eye during a hypertensive emergency. Ophthalmological examination showed serous retinal detachment, vitreous haemorrhage and significant suprachoroidal haemorrhage in the left eye. A post-discharge CT scan report revealed an ill-defined hyperdense structure in the left vitreous chamber, raising concerns for a potential choroidal mass. Subsequent ocular oncology evaluation, including a B-scan 8 weeks after initial assessment, demonstrated a lobulated choroidal elevation characterised by heterogeneous hyperechoic internal reflectivity and intrinsic vascularity. MRI later confirmed the presence of a well-defined intra-ocular T1 hyperintense and T2 hypointense lesion of the left eye with post gadolinium enhancement, consistent with a diagnosis of a cilio-choroidal malignant melanoma. This case underscores the importance of maintaining a high index of suspicion for choroidal melanoma in patients with unresolved suprachoroidal haemorrhage and highlights the role of MRI in challenging diagnostic cases.