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Ophthalmology and Visual Sciences

Iris nevus

Iris nevus

Category(ies): Glaucoma, Iris
Contributors: Jesse Vislisel, MD(figure 1); Thomas J.E. Clark, MD (figure 2)
Photographers: Randy Verdick, FOPS (figure 1); Brice Critser, CRA (figure 2)

Iris nevi typically appear as hyperpigmented regions of the iris with minimal disruption of the normal iris architecture. However, they may occasionally be associated with ectropion uveae or sectoral cataract. There are two types of iris nevi, Circumscribed or Diffuse. Circumscribed iris nevi are discrete and often nodular. Diffuse iris nevi, as shown in the first photograph, involve an entire sector or rarely the entire iris. Iris nevi have low risk for malignant transformation. In a large case series, only 8% of iris nevi referred for evaluation at an ocular oncology center transformed into melanoma.

An ABCDEF mnemonic was proposed by Shields to help remember the risk factors for growth:

  1. Age < 40
  2. Blood (hyphema)
  3. Clock hour inferior (4:00 to 9:00)
  4. Diffuse configuration
  5. Ectropion uveae
  6. Feathery tumor margin
  7. [1]

Dilated funduscopic examination showed severe, diffuse optic atrophy OD and bow-tie (band) optic atrophy OS
Figure 1: Iris nevus, diffuse
Dilated funduscopic examination showed severe, diffuse optic atrophy OD and bow-tie (band) optic atrophy OS
Figure 2a: Iris Nevus, diffuse

This is an example of a circumscribed iris nevus. On slit lamp examination, a well-circumscribed, brown mass is situated on the inferior iris without distortion of the surrounding iris architecture or pupil. There is no prominent vascularity to the lesion or "sentinel vessels" seen on the adjacent conjunctiva./figcaption>
Dilated funduscopic examination showed severe, diffuse optic atrophy OD and bow-tie (band) optic atrophy OS
Figure 2b: Iris Nevus, diffuse

On gonioscopy, the lesion appears to sit on top of the iris without distorting or disrupting the normal iris architecture. There is no extension into the surrounding trabecular meshwork/figcaption>
References:
  1. Shields CL, Kaliki S, Hutchinson A, Nickerson S, Patel J, Kancherla S, Peshtani A, Nakhoda S, Kocher K, Kolbus E, Jacobs E, Garoon R, Walker B, Rogers B, Shields JA. Iris nevus growth into melanoma: analysis of 1611 consecutive eyes: the ABCDEF guide. Ophthalmology. 2013 Apr;120(4):766-72. doi: 10.1016/j.ophtha.2012.09.042. Epub 2013 Jan 3.

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