The peeping tom behind the diaphragm of the eye!

A 21-year-old male visited the eye center for a general checkup. The best corrected visual acuity in both eyes was 20/20. Undilated anterior segment finding was unremarkable in the right eye but there was a nodule-like elevation behind the iris of the left eye at the 8 o’clock position. After dilatation, an immobile cyst-like structure was seen behind the iris as shown in [Figure 1] which was around 2*1 mm in size, oval in shape, and not in the pupillary axis as shown in [Figures 2 and 3]. Additional testing helped to rule out infection, cysticercosis, and malignancy. The ocular history was unremarkable. B scan was unremarkable. A diagnosis of benign epithelial cyst was made and after offering surgery the patient elected for observation. The patient is advised to follow-up every 6 months to see for the progression of size and the need for surgery based on that.

Close

Figure 1:

Slit Lamp view of iris cyst.

Export to PPT

Close

Figure 2:

Retroillumination view of iris cyst.

Export to PPT

Close

Figure 3:

Magnified view of iris cyst.

Export to PPT

Iris cysts are relatively uncommon. It can be a reason for a diagnostic dilemma for an ophthalmologist. Iris cysts can be primary or secondary.^[1] Primary iris cyst arises either from the pigment epithelium or from the stroma.^[2] The location of iris cyst can be at the pupillary margin, mid-zonal, iris periphery, or freely floating.^[3] Secondary cysts, on the other hand, can be post-surgical, post-traumatic, drug-induced, parasitic,^[4] inflammatory, or due to intraocular tumors. Drugs likely to be associated with the formation of iris cysts are pilocarpine and latanoprost.^[5] Intraocular tumors giving rise to iris cysts are medulloepithelioma, uveal melanoma, uveal nevus, and metastasis.^[6] Epithelial iris cysts usually do not require surgical intervention, but stromal cysts often need surgery.^[7]