Abstract

The management of iris cysts

Iris cysts are a rare ophthalmic disease, usually asymptomatic or mildly symptomatic. An iris cyst is most often identified by an ophthalmologist during an eye test appointment for a routine examination of the anterior segment of the eye under a slit lamp or at the time of the diagnosis and treatment of another disease, e.g. conjunctivitis or glaucoma. The examination allows detecting changes that affect the color of the iris to a various degree, which enables a differential diagnosis against iris tumor. Often only the protrusion of the iris and asymmetry of the anterior chamber depth are identifiable and a high-resolution ultrasound scan, i.e. ultrabiomicroscopy (UBM), is required. Additional diagnostic tests include optical coherence tomography (OCT) of the anterior segment, which sometimes includes OCT imaging of the vasculature, i.e. OCT angiography (OCT-A). However, UBM has the greatest diagnostic utility for differentiating an iris cyst from a neoplasm, in particular iris melanoma, a life-threatening condition due to possible metastases to parenchymal organs via blood derivatives. Primary iris cysts originating from the pigment epithelium are most often congenital disorders and do not enlarge over time. In a vast majority of cases, no treatment is required and only periodic follow-up is used. Acquired cysts arise in the stroma of the iris, most often after penetrating eye injuries. They are characterized by the penetration of conjunctival or corneal epithelial cells into the iris tissue. They can enlarge and cause permanent damage to the corneal endothelium or block the outflow of aqueous humor from the anterior chamber, leading to glaucoma. As a result, they most often require surgical treatment – puncture or surgical excision.

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