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Figure 1

Figure 2

Figure 3

Photos courtesy of: Carol L. Shields, M.D.
Used with permission. Not to be reproduced.

A 25-year-old woman complained with a history of redness and irritation in the right eye for the past week. There was a history of penetrating eye injury, one year ago. On examination, her best visual acuity was 20/400 in the right eye and 20/25 in the left eye. The left eye was unremarkable. The right eye slit lamp picture is shown above.

1.	What is your clinical diagnosis?
	d -- iris stromal cyst [acquired]
2.	How can you best investigate this patient for diagnosis?
	c -- history and ultrasound biomicroscopy (UBM)
3.	What cannot be done to manage this case?
	a -- observation

The above case is an acquired stromal cyst of iris, supported by history of penetrating trauma. UBM in figure 2 shows a cyst within the substance of iris. Sometimes, iris pigment epithelium can be seen on the posterior aspect of cyst. This cyst needs treatment as it encroaches the visual axis and the patient is symptomatic. [Figure 3 – after treatment] Aspiration or Nd-YAG laser to its wall or excision are different modalities to tackle this situation.

REFERENCES:

1. Shields JA, Shields CL, Lois N, Mercado G. Iris cysts in children: classification, incidence and management. Br J Ophthalmol 1999:83; 334-338.

2. Waelterman JM, Hettinger ME, Cibis GW. Congenital cysts of iris stroma. Am J Ophthalmol 1993: 116; 228-232.