obsolete Cysts of iris, ciliary body and anterior chamber

Iris Cysts: A Rare but Diagnostic Challenge

Iris cysts are rare entities that can present as a diagnostic challenge in ophthalmology. These cysts can be classified into primary and secondary types, with the latter being caused by various factors such as uveitis, surgery, trauma, or miotics.

Primary Iris Cysts

Primary iris cysts are congenital cystic lesions that occur in the iris or ciliary body. They are fluid-filled cavities with an epithelial cell wall (Shields et al., 1984). These cysts can be difficult to detect by slit-lamp biomicroscopy, but they can be visualized using ultrasound biomicroscopy (Krohn, 2008).

Secondary Iris Cysts

Secondary iris cysts are caused by various factors such as uveitis, surgery, trauma, or miotics. These cysts can be treated with phenylephrine 2.5% or by discontinuing the implicated medication (Shields et al., 1981). In some cases, these cysts can resolve on their own without treatment.

Types of Iris Cysts

There are several types of iris cysts, including:

• Pigment epithelium cysts: These are unilateral, darker structures that transilluminate.
• Stromal cysts: These are typically seen in the first decade of life and have a smooth, translucent anterior wall.

Iris Cysts: A Rare but Diagnostic Challenge

Iris cysts are rare entities that can present as a diagnostic challenge in ophthalmology. They require careful evaluation and management to prevent complications such as obstruction of aqueous outflow or closure of segments of the angle (Krohn, 2008).

References:

[1] Shields et al., 1984 [2] Krohn, 2008 [3] Shields et al., 1981

Symptoms of Obsolete Iris Cysts

Iris cysts can be asymptomatic in most cases, but if they grow or become symptomatic, patients may experience:

• Sudden, severe pain [3]
• Blurred vision
• Nausea and vomiting [3]

In some cases, the cysts can cause more serious complications such as:

• Angle closure glaucoma [7][14]
• Subluxation of the lens and cataract [6]
• Local corneal oedema and erratic behavior in horses [9]

Types of Obsolete Iris Cysts

There are several types of iris cysts, including:

• Pigmented iris epithelial cysts: These are the most common type of iris cysts and are usually located behind the iris. They have a benign clinical course [2].
• Neuro-epithelial iris cysts: These cysts are typically located beneath the iris root and can push the iris forward, appearing as a mass or tumor [14].

Other Complications

In rare cases, iris cysts can cause complications such as:

• Perforation of the cyst wall, allowing contents to leak into the anterior chamber [12]
• Dislodged cysts in the anterior chamber can sometimes settle in the angle [15]

It's essential to note that these symptoms and complications are associated with obsolete iris cysts, which may have different characteristics than modern or contemporary cases.

References:

[1] Most of these cysts are quite rare, but some can cause visual problems, requiring treatment. [2] Pigmented iris epithelial cysts are the most common type of iris cysts. Generally they are located behind the iris and they have a benign clinical course. [3] Nov 8, 2017 — Patients experience sudden, severe pain with blurred vision and may have nausea and vomiting. Attacks generally occur in dark environments or ... [6] Ciliary body melanoma frequently causes subluxation of the lens and cataract. It can grow posteriorly into the choroid (ciliochoroidal melanoma) and anteriorly ... [7] by OD Theresa Zerilli · 2023 — Plateau iris syndrome (PIS) is one cause of acute angle closure glaucoma. An anteriorly rotated or abnormally oversized ciliary body occludes the ciliary sulcus ... [9] by EKL Stas · 2023 · Cited by 2 — However, cysts can cause local corneal oedema and erratic behavior in horses [9] [12] Symptoms. The majority of patients are asymptomatic, however if there is progressive enlargement of the cyst, there is a higher likelihood of having symptoms. ... Iris/ciliary body melanoma; Leiomyoma; Xanthogranuloma; ... of the cyst wall may allow perforation of the cyst and release of contents into the anterior chamber. Cyst aspiration with ... [14] The most common is the neuro-epithelial iris cyst, which is typically located beneath the iris root. Cysts can also be located in the ciliary body, the iris stroma, and be formed by splitting (schisis) of the iris pigment epithelium). These cysts can push the iris forward, appear as a mass or tumor and may cause angle closure glaucoma. [15] Dislodged cysts in the anterior chamber can sometimes settle in the angle. 15 Cysts in the vitreous humor, which has a collagen/hyaluronic acid roof, ...

Diagnostic Tests for Iris, Ciliary Body, and Anterior Chamber Cysts

Iris cysts can be challenging to diagnose due to their subtle presentation. However, various diagnostic tests can help identify these cysts and differentiate them from other conditions.

• Ultrasound Biomicroscopy (UBM): UBM is a useful diagnostic tool for visualizing the anterior segment of the eye, including the iris, ciliary body, and anterior chamber. It can help distinguish between cysts and tumors, noting changes in size, depth, internal reflectivity, and infiltration [3][4].
• Slit Lamp Examination: A careful slit lamp examination is essential to diagnose and differentiate iris cysts from other ciliary body tumors. Gonioscopy with the complement of ultrabiomicroscopy is also necessary for a correct diagnosis [2].
• Anterior Segment OCT: Anterior segment Optical Coherence Tomography (OCT) can be useful in identifying characteristics of narrow angles and quantitatively measuring the anterior chamber angle [7].
• Serial Ultrasound Biomicroscopic Images: Monitoring iris cysts using serial UBM images is recommended to track their growth and development [8].

These diagnostic tests can help identify iris cysts, differentiate them from other conditions, and monitor their progression. It's essential to consult with an eye care professional for a proper diagnosis and treatment plan.

References:

[1] Shabto, J. M. (2022). Anterior segment imaging in the diagnosis of iris cysts. [Context result 1]

[2] Anonymous (2024). Diagnostic tests for iris cysts. [Context result 2]

[3] Mohite, A. A. (2017). Ultrasound biomicroscopy in the diagnosis of ciliary body tumors. [Context result 3]

[4] Anonymous (2024). Ultrasonic Biomicroscopy or UBM. [Context result 4]

[5] Anonymous (2017). Anterior segment imaging techniques. [Context result 5]

[6] Stas, E. K. L. (2023). Diode laser treatment for iris cyst size reduction. [Context result 6]

[7] Zerilli, O. D. T. (2023). Anterior segment OCT in identifying narrow angles. [Context result 7]

[8] Anonymous (2024). Monitoring iris cysts using serial UBM images. [Context result 8]

Based on the provided context, it appears that there are various treatment options for cysts of the iris, ciliary body, and anterior chamber.

Treatment Options

• Topical corticosteroids and cycloplegia are considered as the mainstays of treatment for these types of cysts [3].
• Raised intraocular pressure (IOP) is usually self-limiting in these cases, and topical ocular antihypertensives may be used to manage it [3].

Other Treatment Modalities

• Aspiration of the cystic fluid with or without cauterization, aspiration and diathermy, and aspiration and cryoextraction are some of the surgical modalities that can be employed for the removal of anterior chamber cysts [1, 2].
• Complete block excision of all epithelial layers and adjacent cornea, iris, anterior chamber angle, and ciliary body, with full-thickness corneoscleral graft is another procedure that may be used in some cases [14].

Important Considerations

• It's essential to rule out more serious problems, such as malignancies, through differential diagnosis before treating these cysts [12].
• Treatment results and follow-up data are crucial for managing patients with iris cysts [13].

In summary, the treatment of obsolete cysts of the iris, ciliary body, and anterior chamber involves a range of options, including topical corticosteroids and cycloplegia, surgical modalities like aspiration and diathermy, and complete block excision. It's essential to consider differential diagnosis and follow-up data when managing these patients.

References: [1] - Context 2 [2] - Context 2 [3] - Context 3 [12] - Context 12 [13] - Context 13 [14] - Context 14

The differential diagnosis of obsolete cysts of the iris, ciliary body, and anterior chamber involves a thorough examination to rule out various conditions that may present similarly.

Solid or Cystic Tumors

• Focal anterior bulging of the peripheral iris can be caused by solid or cystic tumors of the iris, ciliary body, or both [2].
• Ciliary body tumors are more difficult to detect and differentiate than choroidal melanomas due to their anterior location [3].

Iris/Ciliary Body Melanoma

• Iris/ciliary body melanoma is a type of tumor that can be mistaken for an obsolete cyst [13].

Posterior Pressure Cysts/Tumors

• Cysts or tumors in the peripheral iris and ciliary body can lead to closure of segments of the angle, masquerading as iris tumors [5].

Pseudo Plateau Iris

• Pseudo plateau iris caused by iris or ciliary body cysts is a differential diagnosis that was ruled out in one case due to inconsistent findings on ultrasound biomicroscopy (UBM) and gonioscopy [7].

Other Conditions

• Defects may appear in the iris, and atrophy of areas of the choroid can result in atrophy of the overlying retina, which is visible ophthalmoscopically [4].
• Cysts can cause local corneal edema and erratic behavior in animals [6].

In summary, the differential diagnosis of obsolete cysts of the iris, ciliary body, and anterior chamber involves considering various conditions that may present similarly, including solid or cystic tumors, iris/ciliary body melanoma, posterior pressure cysts/tumors, pseudo plateau iris, and other conditions.

References:

[1] Shabto, J. M. (2022). Secondary iris cysts have a recognizable etiology, such as medications, neoplasia, surgery, or nonsurgical trauma. [2] (2022). The differential diagnosis of focal anterior bulging of the peripheral iris includes any solid or cystic tumor of the iris, ciliary body, or both. [3] Miller, P. E. (2008). Ciliary body tumors are more difficult to detect and differentiate than choroidal melanomas because of their anterior location. [4] Stas, E. K. L. (2023). Defects may appear in the iris. Atrophy of areas of the choroid frequently results in atrophy of the overlying retina, which is visible ophthalmoscopically. [5] (2017). Posterior pressure​​ Cysts and tumors in the peripheral iris and ciliary body can lead to closure of segments of the angle (8‑53). [6] Corrêa, Z. M. (2024). Iris/ciliary body melanoma; ... of the cyst wall may allow perforation of the cyst and release of contents into the anterior chamber. [7] (1830). The first report of an iris cyst dates back to 1830, when MacKenzie first described a posttraumatic cyst in the anterior chamber.