Essential Iris Atrophy

A patient presented to clinic as a referral due to uncontrolled elevated intraocular pressure in the right eye. The patient was on brimonidine, timolol/dorzolamide, and latanoprost in the right eye only. The patient denied a history of previous trauma or intraocular surgery. The visual acuity was 20/50 in the right eye and 20/20 in the left eye. Intraocular pressure was 26 and 11. The slit lamp examination in the right eye was notable for a corneal “beaten bronze” appearance as well as polycoria with a temporal pseudopupil and iridocorneal touch inferiorly and temporally. The left eye had a normal appearance. The fundus exam was notable for asymmetric cupping, right greater than left. OCT RNFL of the right eye showed inferior thinning, while left eye was normal. Baseline HVF 24-2 showed possible early superior arcuate and inferior nasal step, while left eye was full. Baseline specular microscopy showed abnormal large, pleomorphic endothelial cells. The patient underwent tube shunt placement in the right eye with improvement in intraocular pressure. The patient developed a cataract and underwent subsequent cataract surgery. The vision and intraocular pressure have remained stable over several years. There is no evidence of glaucoma progression on OCT RNFL or HVF testing. The patient has mild corneal edema that is stable on topical therapy.

Presentation Date: 11/16/2023

Issue Date: 12/15/2023