D/D OF IRIS LESIONS
Iris neovascularization
(always look at the posterior segment for cause, the first two on the list are the commonest causes)
· PDR
· CRVO
· carotid artery disease
· BRVO
· CRAO
· BRAO
· chronic uveitis
· RD (chronic).
· malignant melanoma
· CCF
· ROP
Iris transillumination
Diffuse
· Albinism
· FHU
· previous acute glaucoma
· post-cataract surgery
· diabetic mellitus
Sectorial
· HZV
· HSV
· ICE
· ICD
· PPD
· Leprosy
· iridoschisis
· previous acute glaucoma
· post-cataract surgery
Peripupillary
PXS
Marfan Syndrom
DM
Sickle cell anemia (extends to collarete)
Mid-periphery
· PDS
· PC IOL sulcus fixated with iris chafing
· Female carrier of ocular albinism
Localized- PI
· Superiorly: PI-laser or surgical (isolated or with SST)
· Inferiorly: post-vitrectomy with silicone oil (Ando's procedure)
Heterochromia
Refers to differences in the iris colour. The differences are best seen in day light; the abnormal eye may be hypochromic or hyperchromic.
In the examination, most common conditions: FHU, siderosis bulbi and congenital Horner's syndrome.
Cases of iris transillumination mentioned above may also give rise to heterochromia if there is significant pigment loss
1) Causes of hypochromia
· Congenital isolated
· Waardenburg's syndrome – (hypertelorism, white forelock, white eyelashes, leukoderma and cochlear deafness)
· Congenital Horner's syndrome
· Fuch's heterochromic cyclitis
· Chronic uveitis
· Post-cataract surgery
2) Causes of hyperchromia
· congenital isolated
· naevus of Ota
· siderosis bulbi
· diffuse iris naevus / melanoma
· Sturge-Weber's syndrome
· rubeosis iridis (differences in iris colour can become obvious if the blood vessels are extensive)
· drug-induced latanoprost
· paradoxical FHU
Corectopia
· congenital (including coloboma)
· iris naevus / iris melanoma
· ectropia uvae
· ciliary body tumours
· ICD
· ICE
· PPD
· post-cataract surgery (especially with vitreous loss or the haptic is displaced)
· post-trabeculectomy
Polycoria + correctopia + glaucoma:
ICD: bilatreral/hereditary/posterior embryotoxon/normal endothelium
ICE: unilateral with corneal endothelial changes
Iris Nevus Syndrome: diffuse nevus (now considered a separate entity from Cogan Reese)
Posterior Polymorphous Dystrophy
Chronic anterior uveitis
Diffuse melanoma
post-cataract surgery (especially with vitreous loss or the haptic is displaced)
post-trabeculectomy
Ectropin uvae:
· Isolated
· With NF
· Rubeosis iridis
Iris mass
Melanotic mass
· Nevus
· Indeterminate melanocytic lesion
· Malignant melanoma
· Adenoma of the pigmented epithelium
· Iris cyst (Primary epithelial)
· Metastases from the SKIN
· FB
Amelanotic mass
· Malignanat melanoma
· Metastases
· Leiomyoma: Iris cyst: (1ry stromal or 2ry)
· JXG
· Inflammatory ganuloma (TB or Sarcoid)
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