Iris cysts in children: classification, incidence, and management - The 1998 Torrence A Makley Jr Lecture

Background-Iris cysts in children are uncommon and there is relatively litt le information on their classification, incidence, and management. Methods-The records of all children under age 20 years who were diagnosed w ith iris cyst were reviewed and the types and incidence of iris cysts of ch ildhood determined. Based on these observations recommendations were made r egarding management of iris cysts in children. Results-Of 57 iris cysts in children, 53 were primary and four were seconda ry. 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 chi ldhood iris cysts. It was most commonly diagnosed in the teenage years, mor e common in girls (68%), was not recognised in infancy, remained stationary or regressed, and required no treatment. The five mid-zonal pigment epithe lial cysts were diagnosed at a mean age of 14 years, were more common in bo ys (83%), remained stationary, and required no treatment. The pupillary typ e of pigment epithelial cyst was generally recognised in infancy and, despi te involvement of the pupillary aperture, also required no treatment. There were nine cases of primary iris stromal cysts, accounting for 16% of all c hildhood iris cysts. This cyst was usually diagnosed in infancy, was genera lly progressive, and required treatment in eight of the nine cases, usually by aspiration and cryotherapy or surgical resection. Among the secondary i ris cysts, two were posttraumatic epithelial ingrowth cysts and two were tu mour induced cysts, one arising from an intraocular lacrimal gland choristo ma and one adjacent to a peripheral iris naevus. Conclusions-Most iris cysts of childhood are primary pigment epithelial cys ts and require no treatment. However, the iris stromal cyst, usually recogn ised in infancy, is generally an aggressive lesion that requires treatment by aspiration or surgical excision.