Pearls for Floppy Iris Syndrome

Abstract

Intraoperative floppy iris syndrome (IFIS) increases the potential for problems during cataract surgery. Although most strongly associated with tamsulosin, cataract surgeons should be aware of other medications that may cause IFIS. Pharmacologic techniques such as intracameral phenylephrine or epinephrine can improve dilation and iris stability. Mechanical strategies include viscomydriasis and devices like iris hooks or the Malyugin Ring (MicroSurgical Technology, Inc., Redmond, WA, US). A careful history to elucidate patients’ risk for IFIS may be the most important step of all, as surgeon preparedness is probably the most significant way to lower risk of complications.