Iris lesions: A review

Iris lesions encompass a broad spectrum of entities ranging from benign pigmentary variants to primary malignancies and secondary infiltrative or metastatic disease. Although many are discovered incidentally and remain asymptomatic, certain lesions may exhibit growth, seeding, hyphema, pigment dispersion, or angle involvement, leading to secondary glaucoma and vision loss. We synthesize contemporary evidence on melanocytic, non-melanocytic, and cystic iris lesions. We highlight a multimodal diagnostic approach incorporating slit-lamp biomicroscopy with serial photography, gonioscopy, iris transillumination, anterior segment optical coherence tomography, and high-frequency ultrasound biomicroscopy to characterize lesion architecture and define posterior extension. Ancillary testing, including dilated fundus examination and cross-sectional imaging, is discussed when ciliary body involvement or extra-iris disease is suspected. Management strategies are summarized, including surveillance thresholds, indications for biopsy, and treatment options for malignant or symptomatic lesions, with particular attention to prevention and control of secondary glaucoma.