Iris cysts in children: classification, incidence, and management

Background—Iris cysts in children are uncommon and there is relatively little information on their classification, incidence, and management. Methods—The records of all children under age 20 years who were diagnosed with iris cyst were reviewed and the types and incidence of iris cysts of childhood determined. Based on these observations recommendations were made regarding management of iris cysts in children. Results—Of 57 iris cysts in children, 53 were primary and four were secondary. There were 44 primary cysts of the iris pigment epithelium, 34 of which were of the peripheral or iridociliary type, accounting for 59% of all childhood iris cysts. It was most commonly diagnosed in the teenage years, more common in girls (68%), was not recognised in infancy, remained stationary or regressed, and required no treatment. The five mid-zonal pigment epithelial cysts were diagnosed at a mean age of 14 years, were more common in boys (83%), remained stationary, and required no treatment. The pupillary type of pigment epithelial cyst was generally recognised in infancy and, despite involvement of the pupillary aperture, also required no treatment. There were nine cases of primary iris stromal cysts, accounting for 16% of all childhood iris cysts. This cyst was usually diagnosed in infancy, was generally progressive, and required treatment in eight of the nine cases, usually by aspiration and cryotherapy or surgical resection. Among the secondary iris cysts, two were posttraumatic epithelial ingrowth cysts and two were tumour induced cysts, one arising from an intraocular lacrimal gland choristoma and one adjacent to a peripheral iris naevus. Conclusions—Most iris cysts of childhood are primary pigment epithelial cysts and require no treatment. However, the iris stromal cyst, usually recognised in infancy, is generally an aggressive lesion that requires treatment by aspiration or surgical excision. (Br J Ophthalmol 1999;83:334–338) The classification, incidence, and management of iris cysts has been covered in recent reports. Iris cysts are classified as primary or secondary types, with the primary cysts being further divided into pigment epithelial or stromal types. Most iris cysts arise from the iris pigment epithelium in adults but the iris stromal cyst characteristically appears in young children. Although there have been several reports on iris stromal cysts in children little has been written about the incidence, natural course, and management of the various types of cysts that occur in childhood. This study was undertaken to determine the types of iris cysts that occur in the first two decades of life and to elucidate their natural course and management. Patients and methods A retrospective chart review was done on all patients coded in our computerised files with the diagnosis of primary iris cyst from 1 January 1974 to 31 December 1996. We extracted from that large series of primary iris cysts all cases of patients who were under 20 years of age at the time of diagnosis which we defined, for the purpose of this study, as childhood iris cysts. These childhood iris cysts were categorised according to a slight modification of a previously published classification of iris cysts (Table 1). Follow up information was obtained on these children by chart review or by contacting the referring physicians. In addition to our comprehensive review of primary iris cysts, we identified in our files four secondary iris cysts that occurred in children under age 20 and they were included in this survey. We determined the incidence of the various iris cysts of childhood as well as the age and sex of the aVected patient and the natural course and management of the lesions. Results Among 251 patients coded with the diagnosis of primary iris cyst, there were 53 in whom the lesion was diagnosed before age 20 years. In Table 1 Classification of iris cysts