Consider different iris lesion forms before final clinical diagnosis

Reviewed by Arun D. Singh, MD

Iris lesions can take several different forms, said Arun D. Singh, MD.

His overarching approach is to make an initial diagnosis on careful exam, generate a narrow differential diagnosis that includes two or three possibilities, and then order ancillary testing, said Dr. Singh, director, Department of Ophthalmic Oncology, Cleveland Clinic, Cleveland. After that, he comes up with a final clinical diagnosis.

Dr. Singh shared diagnostic and management tips for all types of iris lesions. For instance:
 

• Consider different treatment approaches. “You can observe if you think it’s benign,” he said. “If it’s malignant, you can radiate with focal radiation or enucleate if it’s big.”

• Try to differentiate a nevus from iris melanoma. This is not always easy to do, but signs that suggest melanoma include a history of recent growth, size of more than 3 mm, intrinsic vascularity, hyphema, and angle seeding.

• Think about the different entities that could be present in the iris when making a diagnosis. These could include a melanocytic tumor, nonmelanocytic tumors, iris metastases, iris cysts, iridocorneal syndrome, and inflammatory conditions.

• Have anterior chamber optical coherence tomography (OCT), gonioscopy, transillumination, and ultrasound biomicroscopy (UBM) ready to help with diagnosis.

• Use UBM to view the ciliary body. “OCT is good for the iris but not for the ciliary body,” Dr. Singh said. One occurrence not all surgeons may be aware of is ciliary body nevis, he added.

• Lean toward total excision, if feasible.

Reference

1. Singh AD. Small incision guarded hydroaspiration of iris lesions. Br J Ophthalmol. 2017 Mar 14.

Arun D. Singh, MD

E: singha@ccf.org

This article was adapted from Dr. Singh’s presentation during Cornea Subspecialty Day at the 2016 meeting of the American Academy of Ophthalmology. Dr. Singh did not indicate any proprietary interest in the subject matter.