Can be asymptomatic. Ocular surface irritation can occur. Decreased vision or glare symptoms may occur in advanced cases.

• When the epithelial cells grow onto iris, they flatten the iris crypts and often appear gray or cream colored. This membrane can cause variable iris pigmentation and ectropion uvea if it reaches the pupillary margin.

• When the epithelial cells grow onto the corneal endothelium, they can cause a wavy gray or cream colored demarcation line. Extensive endothelial involvement can result in corneal edema.

• Epithelial cells tracking into the angle may cause increased IOP.

• There may be a persistently Seidel-positive wound.

1. Complete ophthalmic examination, including IOP measurement, and fluorescein staining for epithelial defects or a Seidel-positive fistula, and a dilated fundus examination.

2. Anterior segment OCT may be helpful for visualization.

1. If asymptomatic and nonprogressive, can be observed.

2. Low-setting argon laser can be applied to areas of epithelial downgrowth on the iris. This technique is mainly used to confirm the diagnosis of epithelial downgrowth (laser spots cause whitening of epithelial downgrowth but not normal iris) but has been reported to cause regression in some cases.

3. If there is a fistula, surgical intervention to close the fistula, possibly with addition of cryotherapy, should be considered.

4. Surgery to remove all the intraocular epithelial cells can be attempted, but is often extensive and unsuccessful. Intraocular 5-fluorouracil or methotrexate can also be used, but may require multiple injections and has a guarded prognosis.

5. Treat increased IOP with topical medications initially. If uncontrolled, may be an indication for surgical intervention.

Should be followed every 1 to 2 weeks if there are signs of progression, otherwise can be spaced to longer intervals.