Equis ISSN 2398-2977

Iris: prolapse management

Contributor(s): Keith Barnett, Dennis E Brooks, Graham Munroe

Introduction

  • Perforating lacerations or full thickness ulcerations of the cornea are often associated with iris prolapse, collapse of the anterior chamber and severe endophthalmitis.
  • Surgical management is recommended in these injuries especially if the eye is to remain viable and visual.
  • Enucleation   Eyeball: enucleation - transconjunctival    Eyeball: enucleation - transpalpebral  is recommended in cases that are infected or chronically painful.

Uses

  • Treatment of iris prolapse following perforation of the cornea   Iris: prolapse through corneal rupture  .

Advantages

  • Allows thorough exploration of eye, accurate diagnosis and prognosis.
  • Improves chances of returning eye to healthy state, by minimizing healing time and scar formation, and decreasing uveitis   Uveitis: anterior - overview  .
  • Reduction of pain associated with prolapse.

Disadvantages

  • Expensive.
  • Considerable aftercare required.
  • General anesthesia required.

Requirements

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Preparation

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Procedure

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Outcomes

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Prognosis

  • Guarded always, but especially if the wound is small, the anterior chamber reformed by clot and/or uveal tissue sealing the wound and there is limited hyphema.
  • Worse if laceration extends through the limbus to involve the sclera.
  • Differentiate from globe ruptures following impact from blunt objects - 'blow-out' injury - which carry a very poor prognosis and usually necessitate removal of the eye   Eyeball: enucleation - transconjunctival  .
  • Large corneal lacerations are handled as described but carry a poorer prognosis because uveal tissue is more difficult to replace, and corneal closure will require increased numbers of mattress sutures.
  • Prognosis poor if eye is continuously hemorrhaging pre- or post-operatively, if the lens is ruptured, luxated or expelled, and if vitreous is prolapsed into wound or anterior chamber.
  • Prognosis is bad if prolapse due to melting ulcer, is large in size, is an old lesion, or hyphaema is extensive.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Chmielewski N T et al (1997) Visual outcome and ocular survival following iris prolapse in the horse - a review of 32 cases. Equine Vet J 29 (1), 31-39 PubMed.


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