Traumatic Dislocation of Iris - Symptoms and Management Strategies

Introduction

Trauma to the iris can manifest itself in a variety of ways depending on its location and severity. Tears at the pupillary border can injure the sphincter muscle, resulting in an atonic, mydriatic, or partially reactive pupil. Iridodialysis is caused by tears at the iris root. Furthermore, tears may only affect the posterior pigment epithelium, resulting in trans-illumination defects, or they may be full thickness, extending through the iris stroma.

What Is an Iris?

Iris is the colored part of the eye. Iris is located between the lens and the cornea. Muscles in the iris control the pupil. The network of connective tissue, blood vessels, and melanocytes makes up the iris. The stroma of the iris is formed by the connective tissue, which also supplies the elasticity and stretch observed during surgical manipulation. Collagen fibrils of hyaluronic acid are found in this tissue. Aqueous humor can enter the anterior chamber through several crypts in the stroma. The major arterial circle, situated at the anterior part of the ciliary body, and the minor arterial circle, which weaves through the iris stroma, comprise the vascular network. When the iris is injured, bleeding occurs in the anterior chamber, which is caused by this radial vascular network.

What Is the Traumatic Dislocation of Iris?

Traumatic dislocation of iris is when the iris is displaced from its normal position. This can be due to the trauma. The common causes of the dislocation are

• Blunt Trauma: Blunt trauma may be caused by a direct blow to the eye as a result of an accident or sports injuries.

• Penetrating Injuries: This type of injury occurs when a sharp object like glass or metal penetrates the eye.

• Surgical Complications: Iris dislocation is a rare but possible side effect of eye surgery, especially when the lens or anterior segment of the eye is operated on.

What Could Be the Symptoms of Iris Dislocation?

Iris dislocation presents with symptoms such as

• Pain.

• Blurred or distorted vision.

• Photophobia - Sensitivity to light.

• Excessive tearing.

• Redness of the eye.

• Abnormal size or shape of the pupil.

• Changes in vision quality, like the ability to focus.

How Is the Diagnosis Made?

• Medical History: Iris defects causing photic symptoms in patients include glare, haloes in bright light, and difficulty reading. People with mydriatic, atonic pupils report having more glare at night and difficulty focusing up close. Patients should also have a thorough medication history, including the use of steroids or alpha-blockers, as well as a history of surgery, benign prostate hypertrophy, uveitis, and ocular trauma.

• Visual Acuity Test: A visual acuity test is administered to evaluate a person's ability to see at different distances. Reading letters or symbols on an eye chart is required for this.

• Physical Examination: Pupillary dilation should be carried out after the slit lamp examination. The main objective of surgery in patients who present with concurrent iris and ocular lacerations should be to perform a watertight globe closure. Following a successful closure, the degree of iris laceration, the existence of concurrent iridodialysis, lens trauma or subluxation, and the vitreous or retina inside the anterior chamber should all be evaluated. Delaying the repair of the iris laceration will allow for a final evaluation of the posterior segment to be conducted using a B-scan ultrasound or indirect ophthalmoscopy.

• Gonioscopy: If the patient is not presenting with an ocular laceration, a gonioscopy exam should be performed to check for neovascularization of the angle, tears in the iris root, or peripheral anterior synechiae.

Iris dislocation diagnosis is made using a combination of imaging studies, clinical examination, and specialist consultation when needed. Early diagnosis is essential for prompt intervention and management to prevent complications and preserve vision.

How Is Iris Dislocation Managed?

The underlying cause, the severity of the condition, and any related complications all affect how iris dislocation is treated. The following are some typical methods for treating iris dislocation:

Medical Management:

1. Control of Pain and Inflammation: Pain and inflammation can be controlled with over-the-counter or prescription pain relievers and anti-inflammatory drugs.

2. Topical Medications: To treat symptoms and avoid infection, doctors may prescribe eye drops or ointments.

Surgical Procedure:

1. Iris Repositioning: To realign the displaced iris, surgery might be required in certain situations. This may entail employing methods like suturing the iris back into position or performing additional surgical procedures to return it to its original position.

2. Repair of Associated Injuries: Further surgical procedures may be necessary to address any additional ocular injuries, such as damage to the cornea or lens.

After Care:

1. Frequent Follow-Up Appointments: Patients with iris dislocation should schedule routine follow-up visits with an ophthalmologist to monitor the healing process, handle any complications, and modify treatment as needed.

What Could Be the Complications?

Iris dislocation can have several risks and complications, depending on the cause, such as trauma or other factors.

• Increased IOP (Intraocular Pressure): Iris dislocation may cause alterations in the fluid drainage of the eye, which may raise intraocular pressure. Increased pressure may be a factor in glaucoma, a disorder that damages the optic nerve and impairs vision.

• Hyphema: Collection of blood in the anterior chamber of the eyes.

• Iridodialysis: Separation or tearing of the iris.

• Endophthalmitis: Inflammation of the inner layer of the eyes.

• Corneal Edema: Swelling of the cornea due to infection.

• Vitreous Loss.

• Cystoid Macular Edema: Retinal thickening of the macula.

• IOL Decentration or Dislocation: Tear in the capsular bag.

• Glaucoma: Group of eye conditions that damages the optic nerve.

• Retinal Tear.

How Is It Prevented?

Iris dislocation is sometimes unavoidable, particularly in cases of severe trauma, but there are general safety precautions and lifestyle modifications that people can adopt to lower their risk of eye injuries and related complications:

• Wear appropriate eye protection.

• Use safety goggles and glasses in the workplace.

• In case of pre-existing eye conditions, regular checkup is needed.

• Avoid rubbing the eyes.

• Eat a well-balanced diet and do regular exercise for overall well-being that promotes good eye health.

Conclusion

Traumatic dislocation of the iris is a treatable condition. The treatment approach depends on the severity of the condition. It is important for individuals who experience traumatic eye injuries or suspect a traumatic dislocation of the iris to seek immediate medical attention. Early diagnosis and intervention contribute to better outcomes and can help prevent complications. An eye care professional, such as an ophthalmologist, will conduct a thorough examination, determine the appropriate course of treatment, and provide necessary guidance for recovery.