Congenital Iris Nevus

Brown pigmentation of the medial 60% of the left iris was noted in a 40-year old woman. The remainder of the iris was blue, as was the entire right iris. She stated that she had a “spot” of brown in the left iris at birth. The pigmented area had gradually enlarged until puberty and had not changed since then. Her vision was normal. Although iris nevi are common, they are usually not as large as this patient’s. These nevi are typically unilateral. Other causes of hyperchromatism of the iris include oculodermal melanocytosis (nevus of Ota)—a rare congenital condition with associated ipsilateral skin hyperpigmentation.

Iris hyperpigmentation is common in patients with hemosiderosis and is occasionally seen in those with Sturge-Weber syndrome. Use of latanoprost, bimatoprost, or travoprost for treatment of glaucoma may increase iris pigmentation.¹ Iris melanoma is a rare, slow-growing malignancy that usually presents in the fifth decade of life and is more frequent in persons with nevus of Ota. Metastatic carcinoma of the iris most commonly originates from the breast and bronchus and is frequently bilateral. Occasionally, iris nevi may give rise to malignant melanoma.² Therefore, yearly ophthalmic examinations are recommended.