Juvenile Iridoschisis and Dense Cataract in Severe Atopic Eczema: A Rare Case Report and Literature Review

Juvenile iridoschisis is a rare ophthalmic disorder characterised by the splitting of the iris stroma, typically observed in elderly individuals but exceptionally uncommon in paediatric cases. The aetiology remains unclear, though various hypotheses, including genetic predisposition, mechanical trauma and inflammatory mechanisms have been proposed. While iridoschisis has been associated with conditions such as cataract, angle-closure glaucoma and lens subluxation, its link to atopic eczema is poorly understood. This report highlights a rare case of juvenile iridoschisis in a paediatric patient with severe atopic eczema, adding to the limited body of literature on this condition. A systematic review of previously published cases was conducted to analyse clinical patterns, associated ocular findings and potential aetiopathogenic mechanisms. Notably, the presence of concurrent iridocyclitis in this patient raises questions about inflammatory involvement in the disease process, a feature rarely reported in juvenile iridoschisis. Recent proteomic analyses suggest increased vascular permeability and protein leakage in iridoschisis, which may provide new insights into its pathogenesis. Additionally, habitual eye rubbing, a common feature of atopic eczema has been proposed as a mechanical trigger; however, its role remains inconclusive. The lack of long-term follow-up in reported cases presents a significant gap in understanding disease progression, the risk of glaucoma and potential long-term complications. This study underscores the need for further research into the interplay between atopy, ocular biomechanics and immune dysregulation in juvenile iridoschisis, as well as the importance of tailored surgical and postoperative management strategies in affected patients.