Unilateral Congenital Lenticular Pigmentation

In this case report, we describe a rare ophthalmic entity presented as unique unilateral pigmentation of the anterior lens surface in a young myopic woman who otherwise, has a normal ophthalmic examination. We feel that recognition of this rare benign condition would add to the ophthalmologist’s differential diagnosis of unilateral pigmentation and avoid unnecessary concern and follow-up in more potentially progressive disorders such as pigmentary glaucoma. 

A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye and inquired about refractive surgery. 

Case Report

In the absence of signs of intraocular inflammation and other causes of pigmentary dispersion, it has been postulated that the pigmented cells were implanted on the lens surface in utero from the developing iris pigment epithelium. Migration of some of these implanted cells into the visual axis is a possibility and they appear nonprogressive and visually insignificant.

The patient was reassured and prescribed glasses, and booked for regular follow-up. Following discussion with the patient, she opted to have transepithelial photorefractive keratectomy for the right eye myopic astigmatism which improved her unaided vision to 0.8. 

Congenital lenticular pigmentation is a rare benign entity carrying no surgical indications with a relatively good visual response to optical correction. Recognition of this rare benign condition would add to the ophthalmologist’s differential of ocular pigmentation and avoid unnecessary concern and follow-up in more potentially progressive disorders such as pigmentary glaucoma.