Presentation spectrum and management of iris cysts

Iris cysts are benign lesions that arise from iris tissue and are seen clinically in cyst or elevated form. They can be primary, with no etiological cause, or secondary, with etiological cause. Primary iris cysts are divided into epithelial and stromal types, depending upon their clinical characteristics. Epithelial cysts arise between the pigmented epithelial layers of the iris. They can be central, peripheral and middle in relation to the pupil. Stromal cysts arise within the stroma and are not in straight connection with the posterior epithelium. They apparently arise from ectopic surface epithelium, which is trapped in the iris during embryologic development. Secondary iris cysts often arise after ocular trauma or surgery. Recurrent cyst in child: A 3-year-old child with decreased vision since childhood was diagnosed to have an iris cyst on examination under anesthesia. She underwent cystotomy twice and had a recurrence after each procedure. On ultrasound biomicroscopy (UBM), the cyst measured about 5 mm by 6 mm. There was corneal adhesion and scar formation. The lens was cataractous and tilted due to mechanical pressure from the overlying iris cyst. The patient underwent cystectomy with lensectomy and en bloc iridectomy under general anesthesia (Figures 1a to 1f). A glued IOL was implanted. Keratoplasty may be needed in the future if corneal decompensation sets in. The postoperative period showed mild corneal edema with a nicely centered glued IOL.