Floppy Iris Syndrome Causes and Treatment Strategies

Ophthalmological surgery is a delicate procedure to repair an incredibly fragile organ: the eye. Any surgical complications are extremely high risk given that a patient’s sight is on the line. Cataracts surgery is among the most routine eye procedures. However, it’s associated with a potential complication called intraoperative floppy iris syndrome (IFIS). IFIS is a type of small pupil syndrome, also known as miosis. This is categorized as excessive pupil constriction. Floppy iris syndrome also presents as a billowing iris and iris prolapse. IFIS during cataract surgery can potentially derail the procedure and lead to severe iris damage. For the best possible outcome, ophthalmologists must be aware of the patient’s medication history and be prepared for treatment tactics. These strategies include using iris hooks or retractors during surgery and administering Miochol postoperatively. For attorneys pursuing floppy iris syndrome-related injury cases, here’s what you need to know.

Floppy Iris Syndrome Causes and Treatment Strategies

Table of Contents


What is Intraoperative Floppy Iris Syndrome?

Intraoperative floppy iris syndrome is a condition that may occur during ophthalmological surgery. IFIS is defined by certain criteria, including iris shrinkage and iris prolapse at the surgical site. As the name would suggest, floppy iris syndrome symptoms also include an iris that appears floppy or billowing.


Intraoperative Floppy Iris Syndrome Causes

The occurrence of intraoperative floppy iris syndrome has been linked to patients taking tamsulosin. Also sold under the brand name, Flomax, tamsulosin is a urinary retention medication used to treat benign prostatic hyperplasia (BPH) in men. Women may also be prescribed tamsulosin for urinary issues. In addition to its intended purpose, tamsulosin may also impact the receptors that control the iris’s sphincter muscle contractions.

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Understand the surgical errors present in your IFIS case


Intraoperative Floppy Iris Syndrome Treatment

When ophthalmological surgeons encounter IFIS during a cataracts surgery, they have a few best practices for treatment. These include expansion rings and iris hooks/retractors. If used correctly, iris hooks offer a mechanical method for reversing miosis. Further, hooks and retractors can help prevent iris prolapse during surgery.


Floppy Iris Syndrome Post-Operative Care

Clinicians also have options to treat iris prolapse post-surgery. Most important for prolapse reversal is a watertight seal on the wound. Another crucial step is administering Miochol, a chemical solution that causes the pupil to contract.


Surgical Complications & Floppy Iris Syndrome

Surgeons must remain vigilant for signs of IFIS over the course of cataracts surgery. However, the tools and methods for treatment also present operational risks. Iris hooks and retractors can be effective interventions for IFIS. But they can also cause serious iris trauma (excessive stretching or manipulation) if implemented incorrectly.

Ophthalmological surgery presents a steep learning curve to clinicians. Attorneys pursuing IFIS cases should investigate operator error and training level when considering a surgical mismanagement approach.

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