Cell Phone Selfies: Clinching the Diagnosis of Iris Microhemangiomatosis

Abstract

Four patients presented with a history of "blood" or a "dark spot" in the eye captured on cell phone photos. These episodes prompted presentation to an ophthalmologist where they all had normal slit lamp exams without a hyphema at initial evaluation. With evidence of a spontaneous hyphema seen on photos, further testing was performed including iris fluorescein angiography which revealed hyperfluorescent iris margin vascular tufts, confirming the diagnosis of iris microhemangiomatosis in each patient. All cases were managed conservatively, and only 1 needed topical antihypertensives. Without these patient-initiated photos, the diagnosis of iris microhemangiomatosis would likely remain elusive as slit lamp exam was normal at the time of initial examination in all 4 cases. Ophthalmologists should be aware of this rare diagnosis in the event a patient comes with a cell phone selfie documenting a spontaneous hyphema, especially when emanating from pupillary border.

Keywords: Hyphema; Microhemangiomatosis; Pathology of anterior segment; Selfie.

Fig. 1

a Cell phone photograph of the left eye documenting a hyphema originating at the pupillary border. b Slit lamp photo at presentation without a hyphema or visible tufts at the pupillary border. c, d Iris FA demonstrating peripupillary hyperfluorescence secondary to iris microhemangiomatosis of the right and left eye respectively. FA, fluorescein angiography.

Fig. 2

a Patient-initiated left eye cell phone photograph showing a peripupillary hemorrhage. b Slit lamp photo documenting resolution of the hemorrhage at initial evaluation. c Iris FA of the right eye. d Iris fluorescein angiogram of the left eye with peripupillary leakage from iris vascular tufts. FA, fluorescein angiography.

Fig. 3

a Cell phone photo of the left eye with a hyphema originating at the pupillary margin. b Slit lamp photograph documenting resolution of the hemorrhage upon presentation. c, d Iris FA of the right and left eye respectively with peripupillary hyperfluorescence. FA, fluorescein angiography.

Fig. 4

a Cell phone selfie of the left eye with a hyphema emanating at the inferior pupillary margin. b Slit lamp photo of the left showing resolution of the hyphema. c, d Iris FA of the right and left eyes, respectively, demonstrating hyperfluorescence at the pupillary margin. FA, fluorescein angiography.