Gravitational Shifting of a Pigmented Iris Lesion in a Young Boy

Slitlamp videography of the left eye in a 13-year-old boy revealing a lesion measuring 3 × 3 mm in basal dimension that shifted with gravity as the patient tilted his head. The lesion remained in the dependent portion of the anterior chamber when the patient’s face was oriented in an upright position. Iris pigment epithelium cysts appear on the posterior iris surface with brown or black color and can simulate solid melanocytic tumors, such as iris melanoma or iris pigment epithelium adenoma. Like with this patient, after experiencing trauma, these cysts can become dislodged from their anchoring point and float freely in the anterior chamber. This video demonstrates the superior-to-inferior descent of an iris pigment epithelium cyst across the visual axis, coursing purely through t aqueous humor with gravity, offering insight into the dynamic behavior of this lesion. Cyst paracentesis with complete drainage was not necessary in this case since the cyst did not impact the visual axis and was visually asymptomatic. This form of cyst is benign and rarely leads to adverse sequelae; therefore, conservative observation is advised. Click the Related Article link for full details.