Pigmented lesion of the iris

ectopia uvea in a patient with iris naevus

iris melanoma with intrinsic blood vessels

There is a pigmented lesion on the iris (describe the colour and the edge) which is flat/elevated. Look for signs of malignancy 
such as abnormal iris vessels around or within the tumour, ectopia uvea and sectorial cataract at the site of the lesion. 
Note: ectropia uvea may occur in iris lesion which are benign.

Further examination:

  • mention that you like to examine the posterior segment for any extension; alternatively, the iris lesion (especially if it 

  • is at the angle) may be an extension from a lesion behind the iris
  • look at the sclera on the side of the lesion for any dilated vessels (sentinel vessels) indicating that there may be a 

  • lesion at the ciliary body with anterior extension.


1. What is the differential diagnosis of pigmented iris lesion(s)?

2. How would you manage a patient with a pigmented iris lesion?

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