Iris Prolapse Clinical Presentation

  • Author: Guruswami Giri, MD, FRCS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 16, 2011
 

History

  • The iris is a sensitive tissue in the eye. At the time of an iris prolapse, patients often experience pain. Patients with a perforated corneal ulcer frequently provide a history of severe pain that has since subsided.
  • The iris can prolapse after surgery (eg, cataract, corneal transplant), following trauma (eg, corneal laceration, scleral laceration), through a perforated corneal ulcer, or through a corneal melt associated with rheumatoid arthritis.
    • With improvements in microsurgical techniques, iris prolapse after surgery is uncommon.
    • Iris prolapse with a perforated corneal ulcer is rare.
    • In the author's experience, the most common cause of iris prolapse is following trauma; however, the exact incidence is not known.
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Physical

In peripheral iris prolapse, the iris appears as a knuckle of colored tissue, resulting in a partial peripheral synechia. When the prolapse is central, the entire pupillary margin may prolapse, resulting in a total anterior synechia. In patients with a perforated cornea, the prolapsed iris is exposed.

Depending on the duration of prolapse, the appearance of the iris may vary. In cases of recent prolapse, the iris appears viable. With time, the iris appears dry and nonviable. In patients who have undergone corneal transplant surgery or cataract surgery with a clear corneal incision, the appearance of the iris is the same as in a perforated cornea. When the iris prolapses through a scleral wound, it appears as a colored mass beneath the overlying conjunctiva. In this case, the iris remains viable for a long time.

  • The pupil appears peaked in the region of the iris prolapse. The anterior chamber is formed as the prolapsed iris seals the wound. Minimal or no wound leakage occurs. Wound leak is verified using the Seidel test. A drop of 2% fluorescein sodium is instilled in the conjunctival sac. The wound is examined under the slit lamp with cobalt blue light. The fluorescein appears greenish. Wound leak can be easily identified when the fluorescein is diluted by the aqueous humor. Gentle pressure on the eye may be needed to induce leakage.
  • Intraocular pressure is lower than normal, but hypotony is uncommon after iris prolapse.
  • In long-standing iris prolapse, chronic iridocyclitis, cystoid macular edema, or glaucoma may be seen. The prolapsed iris may act as a scaffold for infection, epithelial downgrowth, or fibrous ingrowth. Rarely, sympathetic ophthalmia may occur. Carefully examining the fellow eye for cells and flare is important.
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Causes

Iris prolapse can occur following trauma, after surgery, through a perforated corneal ulcer, or through a corneal melt.

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Contributor Information and Disclosures
Author

Guruswami Giri, MD, FRCS  Vitreo-Retinal Surgeon, Department of Ophthalmology, Permanente Medical Group of Sacramento, CA

Guruswami Giri, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, Royal College of Ophthalmologists, and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Ralph Garzia, OD  Assistant Dean for Clinical and Academic Programs, Associate Professor, College of Optometry, University of Missouri at St Louis

Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  6. Francis PJ, Morris RJ. Post-operative iris prolapse following phacoemulsification and extracapsular cataract surgery. Eye. 1997;11 (Pt 1):87-90. [Medline].

  7. McGwin G Jr, Hall TA, Xie A, et al. Trends in eye injury in the United States, 1992-2001. Invest Ophthalmol Vis Sci. Feb 2006;47(2):521-7. [Medline].

  8. McGwin G Jr, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol. Jul 2005;123(7):970-6. [Medline].

  9. Naylor G. Iris prolapse; who? When? Why?. Eye. 1993;7 (Pt 3):465-7. [Medline].

  10. Taguri AH, Sanders R. Iris prolapse in small incision cataract surgery. Ophthalmic Surg Lasers. Jan-Feb 2002;33(1):66-70. [Medline].

 
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