Table 2
Differential diagnosis of iris nodules with uveitis
| Aetiology | Diagnostic clues |
|---|---|
| Sarcoidosis | Usually a bilateral chronic uveitis with mutton fat keratic precipitates. 11% of cases have Koeppe and/or Bussaca nodules.1,31 Excision of nodules may lead to clinical improvement.32 |
| Fuchs’ heterochromic iridocyclitis | Characteristic stellate keratic precipitates with or without marked heterochromia. 20–30% of cases have small, transparent iris stromal and pupillary border nodules. Nodules seen most often in darkly pigmented individuals.2,33 |
| Infectious uveitis | Usually associated with a history of systemic infectious disease or systemic symptoms such as fever and chills. May have large fluffy or creamy looking nodules. Responds poorly to corticosteroid treatment. |
| Multiple sclerosis | Granulomatous anterior and/or intermediate uveitis with iris nodules. History will often reveal neurological symptoms.4 |
| Vogt-Koyanagi-Harada syndrome | Prominent bilateral posterior segment inflammation often seen with poliosis, vitiligo, and alopecia. May have iris nodules and anterior chamber inflammation during the uveitic phase of the disease.3 |
| Metastatic neoplasm | Greyish white translucent nodules in the setting of malignancy elsewhere. May have other features such as hypopyon, hyphaema, secondary glaucoma, and iris atrophy.34 |
| Post-transplant lymphoproliferative disorder | Usually seen in immunosuppressed children and is often bilateral. Associated with Epstein-Barr virus exposure after organ transplantation.35–37 |
| Lymphoma and leukaemia | Seen in cases of systemic malignancy. May have hypopyon uveitis.38–40 |
| Foreign body | History of ocular trauma or ocular foreign body. May see foreign body in cornea or conjunctiva. Caterpillar hairs have been frequently reported as a cause of iris nodules.41 |
| Primary malignancy | Most common malignancies include melanoma, retinoblastoma, medulloepithelioma, and sarcoma. Pigmented or non-pigmented mass. Often found to have no response to steroids, refractory glaucoma, and hyphaema. Nodules may show growth over time.42–46 |
| Juvenile xanthogranuloma | Yellowish iris nodules often seen with a hyphaema and skin lesions.47 |
| Drug induced | Pinkish fleshy mass has been reported in association with propranolol.48 |
