A 10-year-old boy presented with a history of penetrating corneal injury in the right eye with a stick 4 months ago, for which he had received treatment elsewhere. Now, he presented with redness in the same eye. The best-corrected visual acuity in both eyes was 6/6. On slit-lamp examination of the right eye, there was circumcorneal congestion along with a self-sealed corneal tear scar at 8–9 o’clock position. Grade 1 inflammation was present in the anterior chamber. The pupil was round in shape, and a round, white pearly cyst was seen on the iris, midway between pupil and limbus on the temporal side Figure 1. The lens was transparent, and the fundus was within normal limits. The intraocular pressure was 14 mmHg in the right eye. The left eye was normal on examination. The patient was advised excision of the lesion, but the parents refused any surgical intervention.Figure 1: A pearly cyst on the iris on temporal quadrant in line with the entry woundDISCUSSION Epithelial cysts of the iris may be primary or secondary in nature.1 Secondary iris cysts can develop after intraocular surgery, trauma, inflammation, or long-term use of topical medications like miotics. These secondary cysts develop from epithelial cells of the cornea or conjunctiva that have been transplanted or implanted on the iris through the wound of trauma or surgery.2 Traumatic iris cysts are of two types: the solid-looking cyst or pearl cyst has stratified or cubical epithelium lining the cyst wall, and the serous cyst, which contains straw-colored turbid fluid.3 If the cyst is small and asymptomatic, close observation may be sufficient. However, larger iris cysts can grow and cause pupillary block and secondary glaucoma, uveitis, corneal decompensation, and eventually, a painful blind eye. The surgical intervention can range from minimally invasive techniques such as aspiration of the cyst and laser therapy, to aggressive surgical procedures like block excision. To conclude, a pearl may look beautiful to the eyes but not in the eyes! Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Manveen Kaur (Thu,) studied this question.