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This five-month-old female presented with a lesion at the 2 o’clock position of the left eye as shown in the pictures.  An ultrasound was performed and is shown.  There has been  some evidence of iritis, and there is an increase in the intraocular pressure in the left eye.  There is no evidence of hyphema.  The child is otherwise normal.  There were no complications during the pregnancy or delivery and the child is meeting developmental milestones.

1.	The most likely diagnosis is:
	c -- primary iris stromal cyst The history, clinical appearance and ultrasound results suggest that this is a primary iris stromal cyst.  Retinoblastoma in the anterior chamber occurs late and the eye would be likely to have a large retinal tumor.  Juvenile xanthogranuloma is associated with skin lesions and spontaneous hyphema; cysts of the pigment epithelium are darker.  Lisch nodules can occur under two years of age, but would not be likely to cause the iritis shown in this infant.
2.	Treatment of this condition is:
	e -- all of the above Since all of these quite different treatment techniques have been used, it seems clear that none is all that successful.

References: 1.  American Academy of Ophthalmology Basic and Clinical Science Course, Section 6 (2005-06 edition), Primary iris cysts, page 252.  Later editions may have a different page. 2.  Swan KC.  Iris cysts.  In Current Ocular Therapy, Fraunfelder, F.T, and Roy, F.H. eds , W.B. Saunders Co., Philadelphia, 2000.  Partners in developing countries can access the book online by logging in to the E-Learning section of the website, then selecting from the menu “Current Ocular Therapy”, clicking on the book cover and selecting Section 25 “Iris and ciliary body” from the chapter list.