Intraoperative floppy iris syndrome

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Intraoperative floppy iris syndrome
Classification and external resources
ICD-9-CM 364.81

Intraoperative floppy iris syndrome (IFIS) is a complication that may occur during cataract extraction in certain patients. This syndrome is characterized by a flaccid iris which billows in response to ordinary intraocular fluid currents, a propensity for this floppy iris to prolapse towards the area of cataract extraction during surgery, and progressive intraoperative pupil constriction despite standard procedures to prevent this.[1]

IFIS has been associated with Flomax (tamsulosin), a medication widely prescribed for urinary symptoms associated with benign prostatic hyperplasia. Tamsulosin is a selective alpha blocker that works by relaxing the bladder and prostatic smooth muscle. As such, it also relaxes the iris dilator muscle by binding to its postsynaptic nerve endings. Even if a patient has only taken tamsulosin once in their life, that dose is enough to cause IFIS during cataract extraction indefinitely.[2][3]

IFIS is also associated with finasteride, a medication typically used as first line therapy for benign prostatic hyperplasia and androgenic alopecia. The medication is also associated with cataract formation.[4][5]

IFIS may also be associated with other causes of small pupil like synechiae, pseudoexfoliation and other medications (used for conditions such as glaucoma, diabetes and high blood pressure). IFIS does not usually cause significant changes in postoperative outcomes. Patients may experience more pain, a longer recovery period, and less improvement in visual acuity than a patient with an uncomplicated cataract removal.

The severity of the condition is not linked to the duration of tamsulosin intake.[6]


  1. ^ Chang, D.; Campbell, J. (April 2005). "Intraoperative floppy iris syndrome associated with tamsulosin". J Cataract Refract Surg 31 (4): 664–73. doi:10.1016/j.jcrs.2005.02.027. PMID 15899440. 
  2. ^ Schwinn, D.; Afshari, N. (2006). "α1-Adrenergic Receptor Antagonists and the Iris: New Mechanistic Insights into Floppy Iris Syndrome". Survey of Ophthalmology 51 (5): 501–512. doi:10.1016/j.survophthal.2006.06.011. PMID 16950249. 
  3. ^ Pärssinen, O.; Leppänen, E.; Keski-Rahkonen, P.; Mauriala, T.; Dugué, B.; Lehtonen, M. (2006). "Influence of Tamsulosin on the Iris and Its Implications for Cataract Surgery". Investigative Ophthalmology & Visual Science 47 (9): 3766–3771. doi:10.1167/iovs.06-0153. PMID 16936084. 
  4. ^ Wong, A. C. M.; Mak, S. T. (2011). "Finasteride-associated cataract and intraoperative floppy-iris syndrome". Journal of Cataract & Refractive Surgery 37 (7): 1351–1354. doi:10.1016/j.jcrs.2011.04.013. PMID 21555201. 
  5. ^ Issa, S. A.; Dagres, E. (2007). "Intraoperative floppy-iris syndrome and finasteride intake". Journal of Cataract & Refractive Surgery 33 (12): 2142–2143. doi:10.1016/j.jcrs.2007.07.025. PMID 18053919. 
  6. ^ Cheung, C.; Awan, M.; Sandramouli, S. (August 2006). "Prevalence and clinical findings of tamsulosin-associated intraoperative floppy-iris syndrome". J Cataract Refract Surg 32 (8): 1336–9. doi:10.1016/j.jcrs.2006.03.034. PMID 16863971.