Iris prolapse is a condition where the colored part of the eye, the iris, pushes through an opening in the eye’s outer layers, the cornea or sclera. The iris normally functions to control the amount of light entering the eye by adjusting the pupil’s size. When the iris protrudes, it signifies a breach in the eye’s structural integrity, a serious condition requiring prompt medical attention.
Causes and Symptoms of Iris Prolapse
Iris prolapse can stem from two primary categories of causes: surgical complications or penetrating trauma. Surgical complications most commonly occur following intraocular procedures. During these surgeries, an improper wound closure or a wound reopening can create a pathway for the iris to push through.
Penetrating trauma to the eye is another cause, where an object punctures the cornea or sclera. This opening allows the iris tissue to be forced outwards. Symptoms include a visibly distorted or “peaked” pupil shape. Visible brown or colored tissue on the outer surface of the eye indicates the prolapsed iris. Other symptoms include eye pain, sensitivity to light (photophobia), and blurred or decreased vision.
Medical Diagnosis Process
Confirming iris prolapse involves a detailed clinical evaluation performed by an ophthalmologist. The condition is often apparent upon initial visual inspection due to the visible tissue or distorted pupil. A thorough examination assesses the full extent of the injury and any co-existing damage.
A slit-lamp microscope is a diagnostic tool. It provides a magnified view of the eye’s anterior structures, including the iris, cornea, and anterior chamber. This allows the doctor to locate the wound, determine the amount of prolapsed iris tissue, and check for any leakage of aqueous humor. The ophthalmologist also evaluates for damage to other internal structures, such as the lens or retina, and measures intraocular pressure.
Surgical Treatment Options
Iris prolapse is considered a surgical emergency and requires prompt surgical intervention. The main goals of surgery are to close the wound, restore the eye’s normal anatomical structure, and prevent infection. The prolapsed iris can act as a pathway for bacteria.
Two primary surgical techniques are employed based on the condition of the prolapsed tissue. The first is iris repositioning, where the surgeon carefully manipulates the viable iris tissue back inside the eye through the wound. This method is preferred when the prolapsed iris is fresh, clean, and not severely damaged. The second technique is an iridectomy, which involves the excising or cutting away of the prolapsed iris tissue. This approach is typically chosen when the prolapsed tissue is devitalized, damaged, or has been exposed for an extended period, as removing it reduces the risk of serious complications like intraocular infection.
Recovery and Associated Risks
After surgery for iris prolapse, the recovery process involves several important steps to promote healing and prevent complications. Patients are usually prescribed antibiotic and anti-inflammatory eye drops to prevent infection and reduce swelling. Wearing a protective eye shield is also generally recommended to guard the eye from accidental trauma or pressure. Follow-up appointments with the ophthalmologist are scheduled to monitor healing, assess intraocular pressure, and check for any signs of complications.
The most significant risk associated with an untreated iris prolapse is a severe intraocular infection called endophthalmitis, which can lead to significant vision loss or even loss of the eye. Even after successful surgery, other potential complications can arise, including chronic inflammation within the eye, secondary glaucoma (elevated eye pressure), and corneal astigmatism, which can cause blurred vision due to an irregularly shaped cornea. Some degree of permanent vision impairment may also occur, depending on the severity of the initial injury and the extent of any damage to the eye’s internal structures.