Post-traumatic iris cyst mimicking a tumor: A solid pearl.

A 24-year-old male, referred with a suspected tumor, presented with diminution of vision in OS for 2 months. There was no history of trauma or previous surgery. On examination, best-corrected visual acuity (BCVA) was 6/9 along with a white-colored mass in the superior angle measuring 4.5 × 6 mm with well-defined margins and attached to the iris [Fig. 1a]. A linear corneal scar was visualized at 1'o clock along with localized corneal thinning and intrastromal cyst formation [Fig. 1a and b]. The intraocular pressure (IOP) was normal. The pupillary reflexes were present in both eyes and fundus examination was normal. Normal NCCT head and orbit; ruled out any bony injury or intraocular foreign body. Ultrasound biomicroscope (UBM) and anterior segment optical coherence tomography (ASOCT) revealed a well-defined homogenous mass arising from the iris stroma with a corneal scar and thinning with no evidence of extension in the posterior chamber [Fig. 2a–d]. Further, a detailed history from parents revealed trivial trauma with a fingernail in childhood. Thus, the patient was diagnosed with a post-traumatic solid pearl iris implantation cyst.

Figure 1

(a) Slit-lamp photograph showing a white-colored mass in the superior angle of the anterior chamber measuring 4.5 mm × 6 mm in size with well-defined margins. (b) a linear corneal scar at 1'o clock position measuring 4.5 mm × 1 mm along with localized corneal thinning and intrastromal cyst formation

Figure 2

(a and b) ASOCT image showing a clear delineation of the mass from the posterior corneal surface except the area corresponding to the corneal scar and attachment to iris stroma with overlying corneal thinning. (c and d) UBM photograph showing a well-defined mass in the superior angle with homogenous reflectivity attached to the iris tissue without any extension into the posterior chamber or ciliary body

The patient had been explained about the risk of recurrence and secondary glaucoma after surgery. He opted for observation only and was prescribed glasses and follow-up regularly for IOP monitoring.

Implantation cysts often present as unilateral, solitary, solid white lesions with opaque walls as a pearl (as in our case) or a cystic mass, located in the iris stroma.[123] Moreover, in our case, no evidence of expansion and infiltration into the posterior chamber, well-defined margins, and homogenous mass ruled out the possibility of tumor.[1] Furthermore, the presence of a corneal scar and continuity of the mass with the scar and iris stroma led us to the diagnosis.

To conclude, an iris cyst can present with a mass mimicking iris or ciliary body tumor. Lack of proper history and investigating tools may further add to the confusion.

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This research did not receive any specific grant from any funding agencies in the public, commercial or not-for-profit sectors.

Conflicts of interest

There are no conflicts of interest.