Floppy Iris Syndrome

Aka: Floppy Iris Syndrome

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II. Pathophysiology: Intraoperative Floppy Iris Syndrome

  1. Sudden prolapse and Pupil Constriction in Cataract surgery
  2. Related to Alpha Adrenergic Antagonist medications

III. Causes

  1. Specific Alpha-1 adrenergic Antagonists (highest risk)
    1. Tamsulosin (Flomax)
  2. Non-specific Alpha Adrenergic Antagonists
    1. Terazosin (Hytrin)
    2. Doxazosin (Cardura)
    3. Prazosin (Minipress)
  3. Beta Blockers with Alpha Adrenergic Antagonist activity
    1. Carvedilol (Coreg)
    2. Labetalol (Trandate)
  4. Other agents with alpha-adrenergic Antagonist activity
    1. Risperidone
    2. Clorpromazine
    3. Imipramine

IV. Complications

  1. Tamsulosin (Flomax) increases the complication risk most significantly (as much as 2.3 times)
  2. Complications include
    1. Retinal Detachment
    2. Lost lens fragment
    3. Severe iris defects

V. Prevention

  1. Identify preoperative Cataract patients with any current or prior history of Alpha Adrenergic Antagonist use (even distant use)
  2. Notify the ophthalmologist performing the procedure of this medication use
  3. Surgical procedure can be proactively modified for patients on alpha-1 Antagonists

VI. References

  1. (2012) Presc Lett 19(5): 28
  2. Chang (2008) J Cataract Refract Surg 34(12): 2153-62 [PubMed]
  3. Bell (2009) JAMA 301(19): 1991-6 [PubMed]

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