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Urban Rosenqvist

Irregular iris/pupil?

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In the maternity ward I sometimes come across babies with irregular pupillary shapes.

Not like coloboma but the other way around - small black circles outline the pupil.

Whenever I refer these findings to the ophtalmologist they don´t see it so I have´nt got a name for it.

Does any of you have the same experience? Do you know what it is?

IMG_3328.JPG

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Interesting observation! Do you mean that the opthalmologist did not see the same at all or just did not have a name for it?

I have some vague memories that there are more pigmentforming during the embryonic period - maybe this is some sort of overpigmentation remnant from fetal life??

Maybe you finns some clues here?

http://www.ncbi.nlm.nih.gov/m/pubmed/3507670/

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They dont see it at all which I think implies that it's a dynamic process (also making me look like a fool ;)). 

Once though when it was so pronounced in one baby that I thought vision might get impaired the ophtalmologist acknowledged it and would do a follow up. Even then I got no clear explanation of it. 

I think it could be a normal finding caused by some developmental remnant (as your article points toward)?

Next time I find it, I will do a follow up myself after 2 weeks before I consult an ophtalmologist. ;)

Thank you 

  • Upvote 1

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Tell the ophtalmologist - you got to see it to believe it! 

If you get permission/consent from parents - it would be great to share a photo around here. Maybe someone would not just bring some more confusion, like me...

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Ectropion uvae according to the ophtalmologist.

If you image-search the web for this I don´t think I find something that is spot on the appearance of my patients but I trust the opthalmologist...  

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Bumping this one... a very benign condition but for those interested

Had antoher patient with these findings and I did som more digging on the topic....

It looks like it could be "Iris Flocculus/flocculi" 

I teamed up with the opthalmologist today to see that they would see what I saw :) and she did. They usually call it "epithelial cyst of the iris" and if it´s only on the margin of the pupil they dont check it further. If it´s bigger (like this one covering a third of the caudal part of the pupil) they have follow up checks.   

There are two Pictures showing iris flocculi in the link below

In Figure 2 - A and B

http://www.google.se/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiKs4mUj5_fAhWjAxAIHVV5BB0Q5TV6BAgBEAs&url=http%3A%2F%2Fwww.apjo.org%2FApjo%2FdownPDF%2Fid%2F462.html&psig=AOvVaw2CHiN8-FCSrDAlRPpuCl_R&ust=1544869834309802

 

I also found an old article from 1998 where they describe the phenomenon  "Flocculus neonatorum" - a self resolving benign nodular flocculus of the Iris in the newborn.

https://journals.sagepub.com/doi/abs/10.1177/000992289803700509?journalCode=cpja and they estimate it to be as common as 1 out of 30 newborns so I´m surprised that so few examiners recognise these findings

 

Finally I can sleep peacefully ;) 

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Great to bump this topic!

I made a screen shot of the photo you referred to (below), did those infants have such marked "out-stamped areas" at the iris margin?

Screenshot 2018-12-14 at 21.14.21.png

I also looked into the first suggestion Ectropion uvae, and found something that seemed to look like your first drawing.

download.jpeg

Which one best illustrates your clinical finding?

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Thanks for the pictures! I’ve seen the bottom picture before and that is the only picture of ”ectropion uveae” that looks similar to my findings, although a very mild variant. 

Mostly it looks like the upper pictures although not that extreme and not extending radially outwards onto the iris but only inwards, into the pupil. 

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