Introduction:

We report a case of a 73-year-old Caucasian woman, who comes in our department for floaters and phosphenes for 6 months. The visual acuity (VA) was 20/20 in the right eye (OD) and 20/25 in the left eye (OS), anterior segment examination was normal. On examination of the fundus posterior vitreous detachment is seen in both eyes, in the left eye we observed a hyperpigmented lesion, flat, irregular borders, juxtapapillary 1.5 disc diameters with a well-defined black, slightly elevated papillary lesion and other with edge yellowish well circumscribed irregular papillomacular beam. Angiography was performed and observed a dense hypofluorescence of effect barrier and absence of accessory circulation without contrast diffusion. B-scan ultrasonography showed a uniform hyperechoic lesion. In optical coherence tomography (OCT): hyperreflectivity in the inner layers with rear shadow without the presence of retinal fluid. Magnetic resonance imaging (MRI) is reported as normal. In subsequent revisions do not appreciate changes in visual acuity and the fundus retinography.

Objective:

To present a papillary tumor is rare but it is the most common primary tumor of the optic nerve and its importance in the differential diagnosis mainly with optic nerve melanoma.

Discussion:

It is assessed the tests that should be performed for diagnosis (MRI, ultrasonography and indocyanine green angiography, OCT) and what should be done to monitor these patients (VA, retinography, OCT or visual fields). The importance of carrying out the proper diagnosis and subsequent monitoring of this disease so little prevalence lies in the different treatment of both tumors one benign (melanocytoma) subtle growth over several years can be observed in about 15% of tumors, rapid progressive enlargement is indicative of malignant transformation of melanocytoma which the risk is 1-2% and the other is a malignant tumor (melanoma) whose treatment is completely different.