Retinal astrocytomas are benign glial tumors usually associated with tuberous sclerosis complex or neurofibromatosis. Sporadic bilateral presentation in adults is rare and can mimic retinoblastoma both clinically and radiologically, leading to misdiagnosis and potentially unnecessary enucleation. We report a unique case of a 33-year-old congenitally blind man with bilateral atrophic bulbi who presented with a progressively enlarging, painless mass from the right eye. Radiological findings suggested adult retinoblastoma, prompting enucleation. Histopathology confirmed retinal astrocytoma, supported by strong glial fibrillary acidic protein (GFAP) positivity on immunohistochemistry. Due to the aggressive behavior and high proliferative index, the patient underwent right eye exenteration and left eye enucleation. Histological findings were consistent in both eyes. This case highlights the importance of considering retinal astrocytoma in the differential diagnosis of intraocular tumors in adults and underscores the need for histopathological confirmation to avoid overtreatment.
Rashmi et al. (2026) studied this question.