Floppy Iris Syndrome And Flomax

Television watching has become a national pass time in the United States, and along with it commercial exposure. We often hear, and see new products and drug manufacturers now use this medium to advertise their pharmaceuticals. The problem that often arises is that the viewer does not know what the new drug is used for, or what the drug's side affects are. The commercials, by law must include disclaimers about potential problems with the drug, but the layperson doesn't understand what they mean.

One such drug is Flomax, which always instructs the viewer to inform his/her eye doctor about the use prior to cataract surgery. What on earth would a prostate drug have to do with a cataract? The answer is Floppy Iris Syndrome.

Flomax, and drugs like it such as Uroxatrol, Hytrin, Cardura, Proscar and even Saw Palmetto which is over the counter all will cause the Floppy Iris Syndrome. They are all work by blocking Alpha-1A receptors in patients with enlarged prostates. The drugs minimize contraction of the muscle fibers in the prostate. The issue that arises is that these drugs also block these same receptors in the dilating muscles in the iris. This pharmacological reaction prevents the eye from dilating, and results in very poor muscle tone in the iris. Since the constrictor muscles are still functioning well the pupil remains small with a billowing iris body.

This affected iris then demonstrates a triad of findings. The first is a fluttering iris that billows back and forth in response to the normal aqueous humor flow. It looks like a sail on a boat blowing in the wind. The second is the progressive pupillary constriction during surgery. This requires the use of special iris retractors during surgery. This may also permanently damage the iris and pupil. Special care must be employed during this procedure. The final part of the triad is the most serious. Due to the lack of muscle tone in the iris, when surgery is performed it always gets sucked out the the surgical wound. This is called iris pr0lapse. When it occurs it substantially complicates the procedure. It can lead to disaster if not handled correctly immediately.

While making the surgeon aware of this drug use is very important, discontinuing its' use prior to surgery does not eliminate the complication. Once the Flomax has been used, the affect on the dilating muscles is permanent. When the drug has been used, special care and preparations must be made prior to any eye surgery. It may also bring with it an increased rate of surgical complications such as vitreous loss, and parts of the natural lens remaining in the eye post surgically.

In short, any drug that one is taking must always be told to the surgeon during the initial consultation. It can, and often does affect preparation and performance of a surgery.