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Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 999

Visible iris sign - A sign with significance

Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Bijnya B Panda
B-3,202, Shreekhetra Residency, Aiginia, Bhubaneswar, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1082_22

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How to cite this article:
Panda BB, Bhatt B, Dash N. Visible iris sign - A sign with significance. Indian J Ophthalmol Case Rep 2022;2:999

How to cite this URL:
Panda BB, Bhatt B, Dash N. Visible iris sign - A sign with significance. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Nov 27];2:999. Available from: https://www.ijoreports.in/text.asp?2022/2/4/999/358145

A 29-year young female was referred to our ophthalmology clinic for treatment of her progressive drooping of the right eyelid for the past ten years. She gave a history of squinting since childhood with the best-corrected visual acuity of 6/18 in both eyes with progressive drooping and recurrent bouts of eyelid swelling. She gave a history of previous eyelid surgery three years back without any significant improvement in palpebral fissure height. There was no written documentation of the eyelid procedure. On examination, she had very thin papery skin over the eyelid with complete ptosis with poor levator function [Figure 1]a. The iris was visible from over the eyelid skin suggestive of a visible iris sign (VIS). This is a sign as described as the visibility of iris color through closed upper eyelid in patients with involutional ptosis or who have undergone prior ptosis surgery.[1],[2] The pathology is probably due to the thinned-out orbicularis muscle and stretching of Muller's muscle. She also had tarsal ectropion and lacrimal gland dacryops [Figure 1]b. She was managed with dacryops excision, lateral tarsal strip procedure (for tarsal ectropion), and frontalis sling for ptosis correction. Postoperatively, she had a good cosmetic and functional outcome [Figure 1]c. Correct preoperative identification of this VIS can help predict intraoperative difficulties, proper patient counseling, and procedure selection.
Figure 1: (a) Preoperative clinical photo showing complete ptosis with visible iris sign (marked with white arrow). (b) Lower eyelid tarsal ectropion with lacrimal gland prolapse. (c) Postoperative clinical photo showing a good cosmetic and functional outcome

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Malhotra R, Salam A, Then SY, Grieve AP. Visible iris sign as a predictor of problems during and following anterior approach ptosis surgery. Eye (Lond) 2011;25:185-91.  Back to cited text no. 1
Kang K. Intraoperative visible iris sign detected during ptosis surgery in seven Korean patients who wore eye masks when sleep. J Cosmet Med 2019;3:64-70.  Back to cited text no. 2


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