Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body.Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainesville, Florida: Triad Publishing Company, 1990. 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.Rappon JM. "Ocular Trauma Management for the Primary Care Provider." Pacific University College of Optometry. Accessed October 12, 2006. "Cornea & External Diseases: Trauma: Traumatic Iridodialysis." Digital Reference of Ophthalmology. Accessed October 11, 2006. Iridodialyses often accompany angle recessionSullivan BR. "Glaucoma, Angle Recession". eMedicine.com. August 16, 2006. Accessed October 11, 2006. and may cause glaucoma or hyphema. Hypotony may also occur. Complications Those with traumatic iridodialyses (particularly by blunt trauma) are at high risk for angle recession, which may cause glaucoma. 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.
Causes Iridodialyses are usually caused by blunt trauma to the eye, but may also be caused by penetrating eye injuries."Glaucoma: Angle Closure: Traumatic Iridodialysis." Digital Reference of Ophthalmology. Accessed October 11, 2006. An iridodialysis may be an iatrogenic complication of any intraocular surgery"Manual Small Incision Cataract Surgery: Intraoperative Complications." ORBIS International Inc. Accessed October 11, 2006. and at one time they were created intentionally as part of intracapsular cataract extraction. Iridodialyses have been reported to have occurred from boxing, airbag deployments, high-pressure water jets, elastic bungee cords, bottle caps opened under pressure, water balloons, fireworks, and various types of balls.
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. 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 Eye injury
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