Waking Up With Cloudy Vision

A 63-year-old woman was referred by optometry after waking up with cloudy vision in the left eye and an ache around the left brow. Visual acuity was 20/20 OD and light perception OS. Intraocular pressure (IOP) was 15 mm Hg OD and 54 mm Hg OS. Anterior segment examination of the left eye was remarkable for a large cystic iris stromal lesion from the 2- to 7-o’clock position with iris-cornea touch. The anterior chamber was shallow in the area of the enlarged cystic lesion with a large amount of pigmented cells. The pupil was irregular with blood at the pupillary margin. Her intraocular lens was not visible because of occlusion by a cystic lesion behind the iris (Figure 1). Her ocular history was notable for indiscriminate trauma to her left eye, primary open-angle glaucoma in both eyes treated with dorzolamide hydrochloride and brimonidine tartrate, and pseudophakia in both eyes. Four years prior, an inferior cystic iris stromal lesion was discovered in the left eye that measured approximately 5 × 2 mm in basal dimensions at the slitlamp. Fine-needle aspiration was negative for malignancy, and the lesion was managed by close follow-up.