Multiple iridociliary cysts: One entity with various clinical presentations

Iris cysts have a wide range of clinical manifestations ranging from totally asymptomatic to full-blown glaucoma. The aim of this report is to present three patients with multiple bilateral iridociliary cysts. Each one of them had a different stage of glaucoma and required individualized management.

All three patients presented to our clinic. Patient 1 was a 25-year old female with no symptoms and normal intraocular pressure (IOP), Patient 2 a 20-year old female with cup-disk asymmetry and nocturnal IOP spikes and Patient 3 a 69-year old male with chronic angle closure, uncontrolled IOP on maximum medical therapy and optic nerve cupping. During clinical evaluation, gonioscopic findings raised the suspicion of possible multiple bilateral iridocilary cysts, which were then verified with ultrasound biomicroscopy in all patients. Each case was managed differently; Patient 1 was opted for observation, Patient 2 was started on prostaglandin analogue and Patient 3 underwent trabeculectomy with Mitomycin-C.

Although iris cysts represent a relatively rare entity, patients with this anomaly can be encountered in our everyday clinical practice. They may be totally asymptomatic, where observation alone suffices, or at the other end of the spectrum, they may present with full-blown glaucoma, requiring traditional glaucoma surgeries. Considering the wide variety of clinical manifestations and that management may differ depending on the diagnosis, it is highly important for clinicians to carry out a careful examination, especially in patients with narrow angle. In cases of high suspicion for iris cysts, ancillary testing, such as Ultrasound Biomicroscopy, should be performed for the definite diagnosis as well as for the exclusion of malignancies.