Benign lesions of the iris

Question 1

Etiology of iris cyst

Answer 1

Idiopathic
Topical prostaglandins and miotics
trauma or surgery

Question 2

Symptoms of iris cyst

Answer 2

Asymptomatic
Visible iris growth if stromal
Blurred vision

Question 3

Signs of an epithelial iris cyst

Answer 3

Solitary, smooth, dome shaped elevation of the iris. Unable to view unless in the pupil.
Appears as a darkly pigmented lesion that transilluminates.
May detach and float freely in AC

Question 4

Signs of a stromal iris cyst

Answer 4

Solitary, smooth, translucent lesion on the surface of the iris. Transilluminates.
May extend into the pupil.
May detach and float freely in AC

Question 5

Difference between epithelial and stromal iris cyst

Answer 5

Epithelial is darkly pigmented.
Stromal is translucent.

Both transilluminate and can extend into pupil. Both may detach and float freely in the anterior chamber.

Question 6

Complications of an iris cyst

Answer 6

If it becomes large enough, it could block the TM.

Question 7

Which is more common? Iris epithelial or stromal cysts?

Answer 7

Iris epithelial.

Question 8

__% of iris epithelial cysts are in the peripheral iris

Answer 8

75%

Question 9

Congenital iris epithelial cysts

Answer 9

Iris flocculi.
Bilateral, multiple cysts at the pupillary margin.
May enlarge and shrink over time.

Question 10

Another name for iris freckle

Answer 10

Iris ephelis

Question 11

What is an iris freckle

Answer 11

Excess pigment of the iris STROMA

Question 12

Signs of an iris freckle

Answer 12

Visible discoloration of the iris.
Tan to brown, flat circumscribed pigmentation on the anterior iris surface. May occur in one or multiple areas.

Typically inferior and small. Normal iris architecture.

Question 13

Where is an iris freckle usually locked

Answer 13

Inferior. Usually small and has normal iris architecture .

Question 14

Does an iris freckle have any malignant potential? What percentage of people does it occur in?

Answer 14

No malignant potential

60% of people

Question 15

Iris nevus. What is it?

Answer 15

Benign tumor of the iris stroma.

Question 16

Location of iris cysts, freckles, and nevi

Answer 16

Cysts can be located in stroma or epithelium. More common in the epithelium. (75% in periph epithelium)

Freckles are located in the stroma

Nevi are located in the stroma.

Question 17

When do iris nevi appear?

Answer 17

Often appear during puberty.

More concerning if it appears later in life

Question 18

Signs of an iris nevus

Answer 18

Tan to brown, flat or slightly elevated, circumscribed lesion in the iris stroma.

One or multiple lesions.

Could be melanotic.

Question 19

Common location and size of iris nevus

Answer 19

Typically inferior, less than 3mm in diameter, and less than 1mm thick.

Question 20

Complications of iris nevus

Answer 20

Does have malignant potential.

Most important sign: documented growth. However, size my increase during puberty.

Question 21

Iris nevus occurs in ___% of people.

Answer 21

5%

Question 22

Difference between iris nevi and freckles

Answer 22

Iris nevi are larger and deeper
Iris nevi have malignant potential, freckles do not.
Iris nevi- follow up is life long. Growth may occur after several years of inactivity.

Question 23

2 variants of iris nevi

Answer 23

1. Diffuse nevus. Flat with indistinct margins. Typically occurs in patients with congenital ocular malanocytosis.
2. Lisch nodules. Small bilateral iris nevi in patients with NF1.