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

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Ontology: Floppy iris syndrome (C1735601)

Concepts Pathologic Function (T046)
ICD9 364.81
ICD10 H21.81
English Floppy iris syndrome, floppy iris syndrome, floppy iris syndrome (diagnosis)
Dutch floppy iris-syndroom
German Floppy Iris Syndrom
Italian Sindrome dell'iride a bandiera
Portuguese Síndrome de íris hipotónica
Spanish Síndrome del iris flácido
Japanese 虹彩緊張低下症候群, コウサイキンチョウテイカショウコウグン
French Syndrome de l'iris hypotonique
Czech Syndrom plovoucí duhovky
Hungarian Lebegő (floppy) írisz szindróma