Presentation
An 84-year-old Caucasian female presented for evaluation of a right iris lesion with associated symptoms of glare and light sensitivity for the preceding three months. She had had a similar occurrence approximately two years earlier, and vaguely recalled that it resolved after treatment with a laser procedure. The patient was referred to the Ocular Oncology Service at Wills Eye Hospital for further evaluation and management.

Figure 1. External photography of the right eye (A) shows a cystic iris lesion inferiorly measuring 10 mm x 6 mm, as well as blepharopigmentation in the upper and lower eyelids. The left eye (B) reveals similar blepharopigmentation. A magnified view of the right eye (C) depicts the cystic lesion protruding into the anterior chamber and distorting the pupil.

Medical History
Her past ocular history was notable for previous uncomplicated cataract surgery in both eyes, as well a giant retinal tear with detachment in the right eye that required surgical repair. She had bilateral blepharopigmentation (eyeliner tattoos). Her medical history was notable only for hypertension, controlled with atenolol. She had no known allergies, and her family and social history were unremarkable.  
 
Examination
On ocular examination her best corrected visual acuity was 20/60 OD and 20/30 OS. Intraocular pressures were

Figure 2. Anterior segment optical coherence tomography of the right eye (A) shows an iris cyst originating from the stroma and occupying the anterior chamber. Ultrasound biomicroscopy of the right eye (B) confirms an iris cystic lesion extending anteriorly with associated endothelial touch.

8 mmHg OD and 9 mmHg OS. The right pupil was irregularly shaped but reactive and the left pupil was round and reactive. There was no afferent pupillary defect. Extraocular movements were intact and her visual fields were full to confrontation in both eyes.External and slit lamp examination revealed the blepharopigmentation of the bilateral upper and lower eyelids (Figure 1A and 1B). Examination of the right eye was further notable for a cystic mass in the iris protruding into the anterior chamber inferiorly and causing distortion of the pupil (Figure 1C). The iris lesion measured approximately 10 mm x 6 mm and endothelial touch was noted inferiorly. The left anterior segment was unremarkable. Dilated fundus examination of each eye demonstrated a flat retina and intact macula.

Anterior segment optical coherence tomography was performed OD and demonstrated a thin-walled, fluid-filled, cystic lesion in the iris stroma distorting the iris both anteriorly and posteriorly (Figure 2A). Ultrasound biomicroscopy OD confirmed the cystic iris stromal lesion with endothelial touch (Figure 2B).

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