Iris Disorders

Question 1

what iris disorder is caused by abnormal adhesions of the anterior surface of the peripheral iris to the trabecular meshwork & corneal endothelium?

Answer 1

peripheral anterior synechiae

Question 2

these can all cause which iris disorder?
which 2 are most common?
- anterior uveitis
- narrow anatomical angles
- iridocorneal endothelial syndrome
- iridocorneal dysgenesis

Answer 2

peripheral anterior synechiae

- anterior uveitis & narrow anatomical angles most common

Question 3

what procedures can be used to diagnose peripheral anterior synechiae? which one is used primarily?

Answer 3

• gonioscopy (preferred)

- anterior segment OCT

Question 4

what complications can arise from peripheral anterior synechiae?

Answer 4

elevated IOP & angle closure glaucoma

Question 5

what is the management for peripheral anterior synechiae?

Answer 5

• treat underlying cause: uveitis, narrow angles

- IOP lowering medications if necessary

Question 6

what iris disorder is caused by adhesion of posterior iris surface to the anterior lens capsule? where does this adhesion occur?

Answer 6

posterior synechiae

- occurs at pupillary margin where they’re the closest to each other

Question 7

what can cause posterior synechiae?

Answer 7

• anterior uveitis

- trauma

Question 8

what is the management for posterior synechiae?

Answer 8

• manage underlying condition

- 10% phenylephrine to break synechiae

Question 9

what is a complication of posterior synechiae that is usually due to chronic/recurrent uveitis?

Answer 9

seclusion papillae → 360 degrees of iris-lens adhesion

Question 10

in seclusion papillae, what happens to IOP?

Answer 10

significant IOP elevation

Question 11

what iris disorder is caused by the absence of pigmentation in the posterior epithelial layer of the iris?

Answer 11

iris transillumination defect

Question 12

these can all cause which iris disorder?

• pigment dispersion syndrome
• pseudoexfoliation syndrome
• HSV/HZV uveitis
• ICE syndromes
• albinism
• Fuch’s heterochromic iridocyclitis
• trauma
• surgery

Answer 12

iris transillumination defects

Question 13

what are the two most common causes of rubeosis iridis?

Answer 13

CRVO & proliferative diabetic retinopathy

Question 14

what is also known as neovascularization of the iris?

Answer 14

rubeosis iridis

Question 15

how do you manage rubeosis iridis?

Answer 15

• treat underlying disease

- treat elevated IOP from neovascularization of the angle

Question 16

what iris disorder presents as a difference in color between the two irides?

Answer 16

heterochromia iridis

Question 17

these can all cause which iris disorder?

• congenital Horner’s syndrome
• Fuch’s heterochromic iridocyclitis
• chronic anterior uveitis
• trauma
• intraocular foreign body

Answer 17

heterochromia iridis

Question 18

how do you manage heterochromia iridis?

Answer 18

treat underlying condition if present

Question 19

which iris disorder is caused by the failure of the embryonic fissure to close during the 5th week of gestation?

Answer 19

iris coloboma

Question 20

typical colobomas are located where? results in what kind of pupil?

Answer 20

inferonasal quadrant → “keyhole pupil”

Question 21

are colobomas unilateral or bilateral?

Answer 21

can be either or

Question 22

how do you manage iris coloboma?

Answer 22

• cosmetic contact lenses

Question 23

which iris disorder is caused by remnants of tunica vasculosa lentis (vascular network that surrounds lens during embryogenesis)?

Answer 23

persistent pupillary membrane

Question 24

are persistant pupillary membranes progressive or non-progressive? what impact do they have on VA?

Answer 24

non-progressive & usually has no effect on VA

Question 25

what iris disorder is caused by abnormal endothelial cell layer?

Answer 25

iridocorneal endothelial syndrome (ICE)

Question 26

in iridocorneal endothelial syndrome, the endothelial cell layer does what & migrates to where?

Answer 26

proliferate & migrate across anterior chamber onto the iris surface

Question 27

ICE syndrome can result in what?

Answer 27

- glaucoma | - corneal decompensation in many pts

Question 28

what is a possible etiology of ICE syndrome?

Answer 28

possible viral etiology (HSV, Epstein Barr Virus)

Question 29

iridocorneal endothelial (ICE) syndrome is typically unilateral or bilateral? which population is it more common in?

Answer 29

typically unilateral & more common in middle-aged women

Question 30

what is the most common clinical presentation of iridocorneal endothelial syndrome?

Answer 30

Chandler syndrome

Question 31

which clinical presentation of ICE has an abnormal corneal endothelium that has an appearance of hammered silver?

Answer 31

Chandler syndrome

Question 32

in Chandler syndrome, is there corneal edema? if so, what is the severity?

Answer 32

yes → significant corneal edema that may require corneal transplantation

Question 33

what is usually not a prominent feature in Chandler syndrome?

Answer 33

iris atrophy

Question 34

which clinical presentation of ICE syndromes has a less severe presentation of glaucoma compared to the rest?

Answer 34

Chandler syndrome

Question 35

blurred vision & halos are symptoms of which clinical presentation of ICE syndrome?

Answer 35

Chandler syndrome

Question 36

in progressive iris atrophy, what sign predominates?

Answer 36

iris features predominate → marked atrophy & corectopia

Question 37

what is pseudopolycoria & it is a sign of which clinical presentation of ICE syndromes?

Answer 37

multiple hole formations within the iris | - sign of progressive iris atrophy

Question 38

what is ectropion uveae? and it is a sign of which clinical presentation of ICE syndrome

Answer 38

presence of posterior iris pigment epithelium on anterior surface - sign of progressive iris atrophy

Question 39

monocular diplopia & photophobia are symptoms of which clinical presentation of ICE syndrome?

Answer 39

progressive iris atrophy