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In the clinicopathologic analysis of seven cases of circumscribed malignant melanoma of the ciliary body, the earliest and most consistent symptom was a progressive decrease in vision, not correctable with lenses and without apparent clinical cause. This symptom was related to refractive aberrations caused by tumor-induced alterations in the noncataractous lens. Mechanisms responsible for these optical effects included localized changes in lens shape, caused by asymmetric zonular tension or by direct compression, and changes in lens position related to decentration or tilting. Other important findings included segmentally prominent episcleral vessels, slight ocular hypotony, and significant changes in the anterior chamber depth.