Whatever the cause, eyes with pupil problems represent a surgical challenge.

In these cases, fluctuations in anterior chamber depth can induce miosis as surgery progresses. It may also occur in postvitrectomy eyes, highly myopic eyes, and eyes with weak zonules. Pupil constriction can be a side effect of IFIS, as mentioned, or it can be caused by intraoperative iris trauma. 3,4Īlthough IFIS is the most likely cause of a floppy iris, it can also occur in traumatic cataracts that are accompanied by severe damage to the iris or in any condition that causes derangement in the iris dilator muscle tone. IFIS can be classified according to the severity of presentation: mild (billowing only), moderate (billowing and intraoperative miosis), or severe (billowing, miosis, and iris prolapse). Largely associated with the use of systemic alpha-1 blockers such as tamsulosin, IFIS may also be linked to other systemic medications, such as nonselective alpha-blockers 2 that may cause a decrease or lack of iris dilator smooth muscle tone. This condition is characterized by poor dilation of the pupil, intraoperative progressive miosis, billowing of the iris tissue, and iris prolapse through the ocular incisions during cataract surgery. Awareness of intraoperative floppy iris syndrome (IFIS) has increased since its description in the past decade by Chang and Campbell, 1 leaving surgeons to determine the best surgical course for these patients. In the presence of such conditions, it may be difficult to dilate the pupil with current dilatation protocols.įloppy iris. The major causes of small pupil include pseudoexfoliation (PXF) syndrome, diabetes, the use of certain systemic drugs, age-related pupil dilator atrophy, trauma, uveitis, long-term use of miotics for glaucoma, and multiple types of previous surgeries including trabeculectomy and phakic lens implantation. When faced with a challenge such as a small pupil, a floppy iris, or intraoperative miosis, the best approach is to pinpoint its cause and deploy a plan of attack before it has a negative effect on the surgical outcomes. Pupillary problems are commonly associated with increased intra- and postoperative complications. Removing a Hypermature White Intumescent Cataract Solutions for Surgically Induced Astigmatism Management of Anterior and Posterior Capsular Tears Long-Term Data on LASIK Versus PRK: Comparing the Benefits of PRK and LASIKįeature Story: Customized Ablations for Better Visual Outcomesįeature Story: Wavefront-Optimized Treatments for Advanced Surface Ablationįeature Story: Improving Clear Corneal Wound Integrityįeature Story: OcuSeal Liquid Ocular Bandage Long-Term Data on LASIK Vesrus PRK: Long-Term Data Show Both PRK and LASIK to be Safe, Effective Long-Term Data on LASIK Versus PRK: LASIK Versus Surface Ablation: Comparison of Efficacy

Atrophic miotic pupil