Anterior Uveitis,More Than A Red Eye : Atypical Presentation With Inflammatory Iris Cyst

This case reports an unusual presentation of anterior uveitis in which an inflammatory iris cyst was the precipitating factor in a patient who was asking for refractive surgery. Although uveitis is most frequently due to either autoimmune or infectious causes, this case illustrates the importance of ultrasound biomicroscopy (UBM) in diagnosing occult iris cysts not visible on routine slit-lamp or AS-OCT imaging.
The patient was effectively managed with topical NSAIDs and steroids alone without needing any invasive procedure. This case confirms the importance of multimodal imaging, especially UBM, in thediagnosis and management of anterior uveitis with an unusual presentation.

This case was seen in our outpatient clinic , the patient presented with anterior uveitis and chronic AC cells had ultrasound biomicroscopy (UBM) for further anterior segment assessment. UBM established an inflammatory iris cyst, and the patient was treated accordingly with topical steroids and NSAIDs. The cyst and inflammation resolved fully in 2 weeks, without the need for surgery. Follow-ups were done regularly to ensure long-term remission and stability.

A [38]-year-old [female] presenting with unilateral ocular redness, photophobia, and mild pain of a few weeks' duration but main complaint was asking for lasik correction. On slit-lamp examination, anterior chamber (AC) cells and mild flare were noted, without synechiae or keratic precipitates. Intraocular pressure was normal, and the posterior segment was normal. The patient was initially treated with topical steroids and NSAIDs, with partial improvement in inflammation but with persisting AC cells.
Due to the unusual presentation, ultrasound biomicroscopy (UBM) was done, which demonstrated a discrete, cystic lesion of the iris stroma, in keeping with an inflammatory iris cyst. There was no malignancy, vascularization, or angle involvement.

The patient was continued on prednisolone acetate QID and nepafenac TID, with eventual resolution of the AC inflammation and the cyst in 2 weeks. No recurrence was noted at 2 months follow-up, and no surgery was necessary. This case illustrates the utility of UBM in diagnosing unusual cases of anterior uveitis and shows that inflammatory iris cysts can be managed completely with directed medical therapy alone, without the need for invasive surgery.

This case highlights the importance of careful iris examination in anterior uveitis cases to exclude underlying cyst or malignancy when inflammation is not responding to treatment.

UBM helped in making a diagnosis of an inflammatory iris cyst with resultant targeted therapy.

Topical NSAIDs and steroids led to resolution, obviating the need for surgery.

Take-home points: All uveitis may not be inflammatory, UBM needs to be kept in mind in atypical cases, and it is crucial to differentiate benign cysts from malignancy for appropriate management.