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Purpose: To report on the utility of intraoperative optical coherence tomography (iOCT) in the treatment of a traumatic iris cyst with aspiration and alcohol injection. Observations: A 61-year-old male, with a past ocular history of a left corneoscleral laceration in 1982, presented with gradual onset of blurring of vision in 2021. Examination revealed a large iris stromal cyst. He subsequently underwent iOCT guided iris stromal cyst aspiration and absolute alcohol injection. Conclusions and importance: Our case demonstrated the efficacy of iOCT to aid in direct visualization and safe guidance of the alcohol into the iris cyst, reducing the risk of collateral damage.