Table 1.
Differential diagnosis of iris mammillations.
| Morphology/Localization | Clinical features | ||
|---|---|---|---|
| Iris mammilations | Multiple verrucous excrescences, or small elevations, distributed diffusely on the anterior iris surface. Usually bilateral. |
May be associated with anterior segment malformation. | |
| Lisch nodules | Fluffy texture. Brown colored in blue or green iris and pale in brown iris. Irregularly placed. | Systemic stigmata of neurofibromatosis (cutaneous and central nervous system lesions). | |
| Granulomatous iridocyclitis | Nodules features are widely variable, differing among etiologies (sarcoidosis, infectious, Fuchs'iridocyclitis). | Anterior chamber cells, flare, and hypopyon. Iris dyscoria and posterior uveitis may be present. | |
| Juvenile xanthogranuloma | Nodular, well-circumscribed, thickened, orange-colored mass. Diffuse: thin coating or film, blunting the normal iris crypts. Unilateral. |
Presentation in early childhood. Iritis, hyphema, secondary glaucoma, neovascularization. May present characteristic skin lesions. | |
| Coogan Reese syndrome | Pigmented, pedunculated nodules surrounded by flat iris stroma, loss of the normal iris architecture. Unilateral. |
Peripheral anterior synechiae, dyscoria, iris atrophy and glaucoma. | |
| Iris solid tumors | Tapioca melanoma | Lightly pigmented multiple nodules or irregular large single nodules. Randomly situated (multiple) or inferior situated (single). | Rare (1% of melanocytic iris tumors). Slow grow pattern. Glaucoma in 1/3 of patients. |
| Melanoma | Usually in inferior quadrant. | Rare (4% of uveal melanoma). Primarily in the Caucasian population. | |
| Nevus | Usually in inferior quadrant. | Most frequent (60%) melanocytic iris tumor). Low risk for growth into melanoma. | |
| Iris cyst | Primary | Single or multiple. Regular borders, smooth surface, thin wall, clear fluid content. Usually unilateral (90%), at mid zonal iris (adults) and pupillary margin (children). | Largely asymptomatic, non-progressive. Unusual. |
| Secondary | Usually solitary, thick walls, irregular borders and surface, distortion of iris architecture. Unilateral, any local in iris surface. | History of trauma, surgery, inflammation. Extension occurs over cornea, iris and lens. Iris bombé, secondary glaucoma, iritis, complicated cataracts. |