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Floppy iris syndrome and cataract surgery

Enright, Jennifer M.; Karacal, Humeyra; Tsai, Linda M.

Current Opinion in Ophthalmology: January 2017 - Volume 28 - Issue 1 - p 29–34
doi: 10.1097/ICU.0000000000000322

Purpose of review Intraoperative floppy iris syndrome (IFIS) occurs in 2% of cataract surgeries and is associated with an increased risk of surgical complications. These complications can be avoided when high-risk patients are identified by preoperative screening and appropriate measures are used intraoperatively. The purpose of this article is to review emerging risk factors for IFIS and to summarize management strategies used in IFIS.

Recent findings Although α1-antagonists in general, and tamsulosin (Flomax, Jalyn) in particular, have long been associated with IFIS, recent studies have more firmly demonstrated the elevated risk of IFIS attributed to tamsulosin. This resulted in a revision of the American Society of Cataract and Refractive Surgery/American Academy of Ophthalmology guidelines on IFIS. Our understanding of additional medications and medical conditions involved in IFIS is also evolving, including an appreciation that women are also susceptible to IFIS. New modifications of techniques used in the intraoperative management of IFIS are also discussed.

Summary Preoperative screening should include both men and women. Current or prior use of α1-antagonists and antipsychotics should be documented, along with hypertension. Surgeons should be prepared to employ a range of perioperative interventions in a graded response to IFIS of different severities.

Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA

Correspondence to Dr Linda M. Tsai, MD, 660 S. Euclid Ave, St. Louis, MO 63110, USA. Tel: +1 314 996 3300; e-mail:

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