Floppy Iris Syndrome

The intraoperative floppy iris syndrome was first reported by Drs. David Chang and John Campbell in 2005. This major discovery showed that the most common prostate medications (such as Flomax) cause iris problems during cataract surgery that can lead to many complications if the surgeon does not anticipate them. Dr. Chang has done extensive clinical research and is considered one of the world authorities on how to avoid and manage these problems.

Patient Information

2006 Flomax Press Releases

Prostate drugs, such as Flomax, can complicate cataract surgery.

By David F. Chang MD

Two of the most common but normal aging ailments are cataracts and enlargement of the prostate. The former produces a gradual blurring of vision, while the latter causes men to urinate more frequently due to incomplete emptying of the bladder. The most commonly prescribed drug for urinary symptoms from an enlarged prostate is Flomax, which relaxes the prostate muscles to improve urinary outflow and emptying of the bladder.

How does Flomax affect my eyes?

Surprisingly, Flomax also affects the iris muscles inside the eye during cataract surgery … a condition called the “intraoperative floppy iris syndrome” (IFIS). Normally, a widely dilated pupil gives the eye surgeon the best view during the cataract procedure. However, Flomax can cause the iris to be floppy and the pupil to unexpectedly constrict during surgery. Particularly if the surgeon is not anticipating this, IFIS can lead to surgical complications. Flomax belongs to the class of prostate drugs called alpha blockers, which also includes Uroxatral, Hytrin, and Cardura. Alpha blockers are also used to treat high blood pressure, kidney stones, and urinary symptoms in women, and all of these drugs can potentially cause IFIS during cataract surgery.

What should patients do?

If you are already taking these drugs, you do not need to stop them. Alpha blockers otherwise do not harm your eyes, but you must inform your ophthalmologist that you are taking them (or have taken them in the past) prior to having any eye surgery. Fortunately, the prognosis for cataract surgery is still excellent because the forewarned ophthalmologist can take compensatory steps to perform the operation successfully.

If you have cataracts and are thinking about taking a medication to treat urinary symptoms, such as from an enlarged prostate, you may wish to first consult with an ophthalmologist. Depending upon individual factors, such as how advanced your cataract is, an ophthalmologist can discuss the timing of cataract surgery, and which prostate medications are less likely to cause IFIS.

Why should I tell my ophthalmologist if I take or have taken medicine for an enlarged prostate?

Researchers have found that medications called alpha-blockers used to treat the symptoms of an enlarged prostate – such as Flomax, Hytrin, Cardura and Uroxatral — can create a risk of complications during cataract surgery. Even if it has been several years since you have taken one of these medications, the risk of complications may still exist. Women are also prescribed alpha-blockers for certain urinary symptoms.

How does Flomax impact cataract surgery?

Alpha-blockers relax muscles in the enlarged prostate to improve urinary flow. This decreases the need to urinate as frequently at night. These same medications also appear to interfere with the muscles that control the iris, the internal structure that gives the eye its color. The pupil, or the dark opening in the center of the iris, must be dilated (or opened widely) to allow the surgeon to operate on the cataract, which sits behind iris in the eye.

In patients who are taking or have taken Flomax or other alpha-blockers, the iris may not stay dilated during surgery. If the iris problems are not anticipated or recognized, there is an increased risk of surgical complications. Flomax does not affect vision and does not pose any other problems with eye health.

Can I still have cataract surgery if I take Flomax?

Yes. If ophthalmologists know that a patient is taking an alpha-blocker or used to take one, they can modify the surgical techniques used during cataract surgery to reduce — but not completely eliminate — the risk of complications.

Should I stop taking Flomax before cataract surgery?

Consult with your ophthalmologist. Some surgeons may recommend stopping the medication for several weeks prior to surgery, but there is also evidence that the modified surgical techniques may not require patients to stop.

Ophthalmologist Information

Two Studies Link Flomax to IFIS (Ophthalmology Management, July 2005)

Intraoperative Floppy Iris Syndrome

Physician’s information

Optometrists Information

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