Congenital Iridodialysis

A male in his forties has difficulty seeing near vision and has also had a routine eye checkup. His best corrected visual acuity (BCVA) was 6/6 (−0.50 DS/−1.25 DC × 90°) and 6/6 (−0.50 DS/−1.50 DC × 10°) for the right eye and the left eye respectively with normal intraocular pressure. On slit lamp examination, the left eye has an iris defect at its root [Figure 1a] with a smooth border [Figure 1b] seen in the inferotemporal region, extending approximately from 4 to 6 o’clock looks like an iridodialysis. There was a smooth border of the iris posterior pigment epithelium layer visible at the smooth border of the defect that looked like a pigment frill of the pupil. Pigment frill is the anterior slight extension of the posterior pigment epithelium of the iris seen in the pupillary border. This extension of the posterior pigment epithelium on the iridodialysis border is unlikely to be seen in traumatic iridodialysis. Anterior segment optical coherence tomography [Figure 2] was conducted with the raster line passing through the iridodialysis border, which further documented the smooth border of the iridodialysis (yellow arrow), along with the smooth border of the posterior pigment epithelium of the iris (white arrow). There was no significant distortion of the undiluted pupil [Figure 1a]. There was a localised lamellar-type cataract [Figure 1c] and colobomatous lens with the absence of zonules [Figure 1d] seen in the same region. On gonioscopy, there were no remnants of iris root tissue, and an underdeveloped ciliary process was seen (1d). There was no history of diplopia or glare. The patient denied any history of trauma, and no signs of trauma were seen suggestive of congenital origin (Congenital iridodialysis).Figure 1: (a) Shows the presence of congenital iridodialysis extending from approximately 4 to 6 o’clock. (b) shows the smooth border of the congenital iridodialysis. (c) localised lamellar type cataract with colobomatous lens with absence of zonules. (d) shows the presence of an underdeveloped ciliary process in indirect gonioscopyFigure 2: Shows the anterior segment optical coherence tomography of the left eye with a raster line passing through the iridodialysis, showing the smooth border of the iridodialysis (yellow arrow) with a smooth border of the posterior pigment epithelium of the iris (white arrow)Congenital iridodialysis, or iridodiastasis,[1,2] is a rare iris condition developed due to defective development of the iris mesoderm during the embryogenesis of the eye. There are certain features in this iridodialysis case suggestive of the congenital origin as described by Sarma CM,[1] such as a non-distorted round pupil, a smooth border of the iridodialysis, and the absence of trauma. Our case has a localised cataract without disturbing the visual axis was seen in the same region of the iridodialysis. Bayer was also mentioned a band line lens opacity was seen behind the congenital iridodialysis.[2] There are only a limited number of cases report available in the literature regarding congenital iridodialysis, and we frame the main differences between congenital and traumatic iridodialysis from them[1-3] in Table 1 along the schematic diagram [Figure 3a and b]. As the patient is completely asymptomatic related to the iris defect, such as no glare or double vision, we plan to keep the patient under observation with regular follow-up.Table 1: The main difference between congenital iridodialysis and traumatic iridodialysisFigure 3: Shows the schematic diagram of congenital and traumatic iridodialysis. (a) shows the congenital iridodialysis with a smooth border of the iridialysis and a round pupil. (b) shows the traumatic iridodialysis with serrated edges and a D-shaped pupilDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.