Iridodialysis Explained

Iridodialysis
Synonyms:Coredialysis

Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body.[1] [2]

Symptoms and signs

Those with small iridodialyses may be asymptomatic and require no treatment, but those with larger dialyses may have corectopia or polycoria and experience monocular diplopia, glare, or photophobia.[3] [4] [5] Iridodialyses often accompany angle recession[6] and may cause glaucoma or hyphema.[7] Hypotony may also occur.[8]

Complications

Those with traumatic iridodialyses (particularly by blunt trauma) are at high risk for angle recession, which may cause glaucoma.[3] This is typically seen about 100 days after the injury, and as such is sometimes called "100-day glaucoma". Medical or surgical treatment to control the IOP may be required if glaucoma is present. Soft, opaque contact lenses may be used to improve cosmesis and reduce the perception of double vision.[3]

Causes

Iridodialyses are usually caused by blunt trauma to the eye,[2] but may also be caused by penetrating eye injuries.[9] An iridodialysis may be an iatrogenic complication of any intraocular surgery[10] [11] [12] and at one time they were created intentionally as part of intracapsular cataract extraction.[13] Iridodialyses have been reported to have occurred from boxing,[14] airbag deployments,[15] high-pressure water jets,[16] elastic bungee cords,[17] [18] bottle caps opened under pressure,[19] water balloons,[20] fireworks,[21] [22] and various types of balls.[23]

Treatment

Iridodialysis causing an associated hyphema has to be carefully managed, and recurrent bleeds should be prevented by strict avoidance of all sporting activities. Management typically involves observation and bed rest. Red blood cells may decrease the outflow of aqueous humor, therefore the eye pressure should be kept low by giving oral acetazolamide (a diuretic given to reduce intraocular pressure). Accidental trauma during sleep should be prevented by patching with an eye shield during night time. Avoid giving aspirin, heparin/warfarin and observe daily for resolution or progression. A large hyphema may require careful anterior chamber washout. Rebleeds may require additional intervention and therapy.

Later, surgical repair may be considered for larger avulsions causing significant double vision, cosmesis or glare symptoms.[4] Surgical repair is usually done by 10-0 prolene suture taking the base of iris avulsion and suturing it to the scleral spur and ciliary body junction.

See also

Notes and References

  1. Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997.
  2. Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainesville, Florida: Triad Publishing Company, 1990.
  3. Rappon JM. "Ocular Trauma Management for the Primary Care Provider." Pacific University College of Optometry. Accessed October 12, 2006.
  4. http://dro.hs.columbia.edu/iridialysis.htm "Cornea & External Diseases: Trauma: Traumatic Iridodialysis."
  5. Brown . SM . A technique for repair of iridodialysis in children . Journal of AAPOS . 2 . 6 . 380–2 . 1998 . 10532731 . 10.1016/S1091-8531(98)90041-6 .
  6. Sullivan BR. "Glaucoma, Angle Recession". eMedicine.com. August 16, 2006. Accessed October 11, 2006.
  7. Kiel . J . Chen . S . Contusion injuries and their ocular effects . Clinical & Experimental Optometry . 84 . 1 . 19–25 . 2001 . 12366340 . 10.1111/j.1444-0938.2001.tb04931.x . 2006-10-11 . https://web.archive.org/web/20060927215821/http://www.optometrists.asn.au/gui/files/ceo841019.pdf . 2006-09-27 . dead . free .
  8. 10.1034/j.1600-0420.2002.800104.x . Behndig . A. . 2002 . Results with a modified method for scleral suturing of intraocular lenses . Acta Ophthalmologica Scandinavica . 80 . 1. 16–18 . 11906298 . free .
  9. http://dro.hs.columbia.edu/trglaucoma.htm "Glaucoma: Angle Closure: Traumatic Iridodialysis."
  10. http://telemedicine.orbis.org/bins/content_page.asp?cid=1-1758-1889-1921 "Manual Small Incision Cataract Surgery: Intraoperative Complications."
  11. Gashau . AG . Anand . A . Chawdhary . S . Hydrophilic acrylic intraocular lens exchange: Five-year experience . Journal of Cataract and Refractive Surgery . 32 . 8 . 1340–4 . 2006 . 16863972 . 10.1016/j.jcrs.2006.02.062 .
  12. Walker . NJ . Foster . A . Apel . AJ . Traumatic expulsive iridodialysis after small-incision sutureless cataract surgery . Journal of Cataract and Refractive Surgery . 30 . 10 . 2223–4 . 2004 . 15474840 . 10.1016/j.jcrs.2004.03.040 .
  13. Beetham . WP. . 1941 . Cataract Extraction with Iridodialysis . Trans. Am. Ophthalmol. Soc. . 39 . 104–15 . 16693243 . 1315004 .
  14. Hazar . M . Beyleroglu . M . Subasi . M . Or . M . Ophthalmological findings in elite amateur Turkish boxers . British Journal of Sports Medicine . 36 . 6 . 428–30 . 2002 . 12453836 . 1724577 . 10.1136/bjsm.36.6.428.
  15. Kenney . KS . Fanciullo . LM . Automobile air bags: friend or foe? A case of air bag-associated ocular trauma and a related literature review . Optometry . 76 . 7 . 382–6 . 2005 . 16038865 . 10.1016/j.optm.2005.06.001 .
  16. Gracner . B . Pahor . D . Bilateral eye injury caused by a high-pressure water jet from a fire hose . Wiener Klinische Wochenschrift . 113 Suppl 3 . 62–4 . 2001 . 15503624 .
  17. Viestenz . A . Küchle . M . Ocular contusion caused by elastic cords: a retrospective analysis using the Erlangen Ocular Contusion Registry . Clinical & Experimental Ophthalmology . 30 . 4 . 266–9 . 2002 . 12121366 . 10.1046/j.1442-9071.2002.00529.x .
  18. Chorich Lj . 3rd . Davidorf . FH . Chambers . RB . Weber . PA . Bungee cord-associated ocular injuries . American Journal of Ophthalmology . 125 . 2 . 270–2 . 1998 . 9467466 . 10.1016/S0002-9394(99)80111-1 .
  19. Viestenz . A . Küchle . M . Eye contusions caused by a bottle cap. A retrospective study based on the Erlangen Ocular Contusion Register (EOCR) . Der Ophthalmologe . 99 . 2 . 105–8 . 2002 . 11871070 . 10.1007/s003470100504 .
  20. Bullock . JD . Ballal . DR . Johnson . DA . Bullock . RJ . Ocular and orbital trauma from water balloon slingshots. A clinical, epidemiologic, and experimental study . Ophthalmology . 104 . 5 . 878–87 . 1997 . 9160038 . 10.1016/s0161-6420(97)30218-8.
  21. Arya. SK. Malhotra. S. Dhir. SP. Sood. S. September 2001. Ocular fireworks injuries. clinical features and visual outcome. Indian Journal of Ophthalmology. 49. 3. 189–90. 15887729.
  22. Sacu . S . Ségur-Eltz . N . Stenng . K . Zehetmayer . M . Ocular firework injuries at New Year's eve . Ophthalmologica . 216 . 1 . 55–9 . 2002 . 11901290 . 10.1159/000048298 .
  23. Purdie . AT . Whyte . IF . Shinty and ocular trauma in north west Scotland . British Journal of Ophthalmology . 82 . 12 . 1445 . 1998 . 9930282 . 1722457 . 10.1136/bjo.82.12.1444a .

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