Medical Retina: Case twelve

This 40 year old man was referred by his optician because of the above  appearance in his right vitreous cavity. He had no previous ophthalmic history of note and the visual acuity was normal in both eyes.

a. What is the diagnosis?

A right vitreous cyst.
The picture shows a free floating vitreous cyst which is spotted with pigment.
b. What is the origin of this lesion?
Vitreous cysts may occur as:
  • congenital
  • remnants of hyaloid system (in which case the cyst is usually attached to the optic disc or suspended from it by a pedicle)
  • associated with diseased eye
In this patient, the absence of ophthalmic history and the free-floating nature of the cyst suggests it is congenital. The exact of origin of congenital vitreous cyst is unknown but the presence of pigment points to the uveal tract.
Some of the congenital cysts may be translucent making it difficult to detect.
c. How would you manage this patient?
Congenital vitreous cyst is benign and does not require treatment. Occasionally, it may present as floater but most of them are asymptomatic
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