Pearl Cyst of the Iris

Description
A rare complication of cataract surgery, the "pearl-cyst" may grow from on and within the iris. The tumors are thought to be caused by displaced conjunctival or epidermal epithelium. There are several reports that rupture of these mucous-containing cysts can cause severe glaucoma (if ruptured).

Slit-lamp photography shows the white pearl-cyst within the temporal iris stroma. In this case, a history of tumor growth and a mild iritis were noted.

Symptoms
Most patients present due to ocular inflammation. They may notice the white tumor growing on the iris.

Diagnosis
The diagnosis of "Pearl Cyst" should be considered when a patient who has had intraocular surgery (cataract, corneal transplant, or filtering for glaucoma) presents with a slowly enlarging white iris stromal tumor. High frequency ultrasound (UBM) has been reported to demonstrate three-layers of material within the cyst.

High frequency ultrasound demonstrates three layers (a mantle, mucus content, and cholesterol crystals at the center).

Treatments
When "Pearl-cyst" of the iris is suspected, complete surgical excision is warranted. Though difficult, the surgeon should try to remove the cyst intact. The mucoid contents have been reported to cause secondary glaucoma. If epithelial tissue is left behind one runs the risk of tumor recurrence.

Histopathology of the Pearl Cyst demonstrates the epithelial cyst lining.

Additional Info
References
1. Epithelial invasion of the anterior chamber. Maumenee AE, Shannon CR. American Journal of Ophthalmology 1956;41:929-943.
2. The possible role of epithelium-bearing surgical instruments in pathogenesis of epithelialization of the anterior chamber. Ferry AP. Annals of Ophthalmology 1971:1:1089-1093.
3. Mucogenic glaucoma and goblet cell cyst of the anterior chamber. Layden WE, Torczynski E Font R. Archives of Ophthalmology 1978;96:2259-2263.
4. Conjunctival Inclusion Cyst of the Iris. Finger PT, Lombardo J, Tello C, Ritch R, McCormick SA. The Archives of Ophthalmology, 1995;113:777-780.

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