The Case of the Affluent Artist With Rapidly Deteriorating Vision

Albert Lowenfels, MD; Patrick Maisonneuve, Eng

Disclosures

August 10, 2010

Summary

In the late 18th century, several decades before the development of cameras, the only way to have a visual memory of a cherished family member was with a portrait painting. Sir Joshua Reynolds, an English portrait painter, was a successful and popular artist of the late 18th century. He worked rapidly, producing an estimated 2000 greatly admired portraits during his lifetime. Unfortunately, like another famous artist -- Leonardo da Vinci -- Reynolds experimented with many different types of pigments, some of which have tended to fade over time.

At the time when Reynolds developed his eye problem, accurate diagnosis was impossible because instruments to examine the interior of the eye had not been invented. He had several symptoms that are characteristic of ocular melanoma: pain, a red bulging eye, diminished vision, and ultimately blindness of the afflicted eye. These symptoms, combined with the discovery of a greatly enlarged liver at the time of his death, strongly suggest that the underlying disease was an ocular melanoma. This is still a rare disease with an appreciable mortality rate, but now, if diagnosed in an early stage, the prognosis has greatly improved. In many patients, carefully applied radiotherapy can avoid the more drastic surgical enucleation of the eye.

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