Unilateral acorea turned cryptic microcoria with contralateral iris coloboma with cataract: a rare misdiagnosed anomaly

Microcoria and acorea are uncommon congenital anomalies characterised by the abnormal development of the pupillary aperture. We report a rare and complex presentation in a male patient in his early 40 s: the right eye demonstrated a cryptic, rudimentary pupillary opening located inferiorly, associated with microphthalmia and retinal detachment, while the left eye exhibited a classic iris coloboma and dense cataract. The right eye showed complete pupillary agenesis refractory to pharmacologic dilation, with no light perception, while the left eye retained limited vision. Slit-lamp and ultrasonography findings confirmed the structural anomalies. No surgical intervention was pursued for the right eye, but cataract management was planned for the left. This presentation highlights the importance of early identification of congenital pupillary abnormalities and the phenotypic variability of ocular developmental disorders.