Microspherophakia with an atypical temporal iris coloboma in a young female

Microspherophakia is a rare congenital lens abnormality characterised by increased anterior-posterior thickness and reduced equatorial diameter, giving the lens a spherical shape. Iris coloboma, typically involving the inferonasal iris, results from incomplete fetal fissure closure. To our knowledge, this is the first reported case of microspherophakia with bilateral atypical (temporal) iris coloboma. An early adolescent patient underwent a syndromic evaluation for multiple congenital anomalies. Ophthalmological examination revealed bilateral temporal notches of the pupillary rim with intact collarettes, suggesting coloboma and strongly pigmented lens zonules with phacodonesis. Additional findings included inguinal hernia, submucosal cleft palate, mitral valve prolapse, microcephaly and high myopia. Management focused on glasses and periodic intraocular pressure monitoring due to preserved visual acuity. This case underscores the variable presentation of probable connective tissue disorders, with atypical ocular features like microspherophakia, temporal iris coloboma and lens subluxation.