What lies beneath? A case of bilateral acorea

Purpose: Bilateral acorea is an extremely rare congenital anomaly characterized by the complete absence of a pupillary aperture. We report a 19-year-old male who presented with progressive bilateral visual loss since childhood. Clinical examination revealed absent pupillary apertures and dense cataracts in both eyes. Anterior segment optical coherence tomography and ultrasound biomicroscopy confirmed uninterrupted iris tissue across the pupillary plane, with associated iridocorneal abnormalities. A central optical iridotomy was performed in the right eye, during which a hypermature Morgagnian cataract was identified and extracted. Postoperatively, a clear visual axis was established, allowing posterior segment evaluation. Visual improvement was limited because of longstanding stimulus deprivation amblyopia. This case highlights the diagnostic challenges and surgical considerations in isolated bilateral acorea presenting in late adolescence. Early recognition remains crucial for preventing irreversible amblyopia, although delayed intervention may still provide anatomical rehabilitation and facilitate visual assessment.