The lesions occur in about 50 to 75 percent of patients with the disorder. A retinal phakoma may have a characteristic appearance of a large, whitish, mulberry-like multinodular lesion. The lesion can easily be mistaken for a retinoblastoma. Therefore, a diligent search for other signs of tuberous sclerosis should be made before inappropriate, unnecessary enucleation is performed. Ungual fibroma on the third toe of the left foot of the man in Figure 3.
Patients can also have plaque-like hematomas and achromic patches on the retina.
Most lesions do not cause visual changes. Renal Manifestations Renal cysts may develop in children with tuberous sclerosis, and renal angiomyolipomas may occur in adults. Renal failure or bleeding angiomyolipomas may cause death. Pain is the most frequent clinical feature of these lesions. An angiomyolipoma greater than 3.5 to 4 cm in diameter should be evaluated angiographically and considered for treatment.