Iridodialysis

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Iridodialysis
ICD-10 H21.5
ICD-9 364.76


Overview

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

Causes

Iridodialysis caused by blunt trauma to the eye

Iridodialyses are usually caused by blunt trauma to the eye,[2] but may also be caused by penetrating eye injuries.[3] An iridodialysis may be an iatrogenic complication of any intraocular surgery[4][5][6] and at one time they were created intentionally as part of intracapsular cataract extraction.[7] Iridodialyses have been reported to have occurred from boxing,[8] airbag deployments,[9] high-pressure water jets,[10] elastic bungee cords,[11][12] bottle caps opened under pressure,[13] water balloons,[14] fireworks[15][16], and various types of balls.[17]

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.[18][19][20] Iridodialyses often accompany angle recession[21] and may cause glaucoma[3] or hyphema.[22] Hypotony may also occur.[23]

Treatment and management

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 should be kept soft by giving oral acetazolamide. 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.[19] 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.

Complications

Those with traumatic iridodialyses (particularly by blunt eye trauma) are at high risk for angle recession, thereby causing increased intraocular pressure (IOP).[18] This is typically seen about 100 days or three months after the injury, and is thereby called 100 day Glaucoma. Medical or surgical treatment to control the IOP may be required if glaucoma is present.[3] Soft opaque contact lenses may be used to improve cosmesis and reduce the perception of double vision.[3][18]

See also

References

  1. Cline D; Hofstetter HW; Griffin JR. Dictionary of Visual Science. 4th ed. Butterworth-Heinemann, Boston 1997. ISBN 0-7506-9895-0
  2. 2.0 2.1 Cassin, B. and Solomon, S. Dictionary of Eye Terminology. Gainsville, Florida: Triad Publishing Company, 1990.
  3. 3.0 3.1 3.2 3.3 "Glaucoma: Angle Closure: Traumatic Iridodialysis." Digital Reference of Ophthalmology. Accessed October 11, 2006.
  4. "Manual Small Incision Cataract Surgery: Intraoperative Complications." ORBIS International Inc. Accessed October 11, 2006.
  5. Gashau AG, Anand A, Chawdhary S. "Hydrophilic acrylic intraocular lens exchange: Five-year experience." J Cataract Refract Surg. 2006 Aug;32(8):1340-4. PMID 16863972.
  6. Walker NJ, Foster A, Apel AJ. "Traumatic expulsive iridodialysis after small-incision sutureless cataract surgery." J Cataract Refract Surg. 2004 Oct;30(10):2223-4. PMID 15474840.
  7. Beetham WP. "Cataract Extraction with Iridodialysis." Trans Am Ophthalmol Soc. 1941;39:104-15. PMID 16693243.
  8. Hazar M, Beyleroglu M, Subasi M, Or M. "Ophthalmological findings in elite amateur Turkish boxers." Br J Sports Med. 2002 Dec;36(6):428-30. PMID 12453836.
  9. Kenney KS, Fanciullo LM. "Automobile air bags: friend or foe? A case of air bag-associated ocular trauma and a related literature review." Optometry. 2005 Jul;76(7):382-6. PMID 16038865.
  10. Gracner B, Pahor D. "Bilateral eye injury caused by a high-pressure water jet from a fire hose." Wien Klin Wochenschr. 2001;113 Suppl 3:62-4. PMID 15503624.
  11. Viestenz A, Kuchle M. "Ocular contusion caused by elastic cords: a retrospective analysis using the Erlangen Ocular Contusion Registry." Clin Experiment Ophthalmol. 2002 Aug;30(4):266-9. PMID 12121366.
  12. Chorich LJ 3rd, Davidorf FH, Chambers RB, Weber PA. "Bungee cord-associated ocular injuries." Am J Ophthalmol. 1998 Feb;125(2):270-2. PMID 9467466.
  13. Viestenz A, Kuchle M. [Eye contusions caused by a bottle cap. A retrospective study based on the Erlangen Ocular Contusion Register (EOCR)] Ophthalmologe. 2002 Feb;99(2):105-8. German. PMID 11871070.
  14. Bullock JD, Ballal DR, Johnson DA, Bullock RJ. "Ocular and orbital trauma from water balloon slingshots. A clinical, epidemiologic, and experimental study." Ophthalmology. 1997 May;104(5):878-87. PMID 9160038.
  15. Arya SK, Malhotra S, Dhir SP, Sood S. "Ocular fireworks injuries. Clinical features and visual outcome." Indian J Ophthalmol. 2001 Sep;49(3):189-90. PMID 15887729.
  16. Sacu S, Segur-Eltz N, Stenng K, Zehetmayer M. "Ocular firework injuries at New Year's eve." Ophthalmologica. 2002 Jan-Feb;216(1):55-9. PMID 11901290.
  17. Purdie AT, Whyte IF. "Shinty and ocular trauma in north west Scotland." Br J Ophthalmol. 1998 Dec;82(12):1445. PMID 9930282.
  18. 18.0 18.1 18.2 Rappon JM. [http://www.opt.pacificu.edu/ce/catalog/10310-SD/Triage.html "Ocular Trauma Management for the Primary Care Provider." Pacific University College of Optometry. Accessed October 12, 2006.
  19. 19.0 19.1 "Cornea & External Diseases: Trauma: Traumatic Iridodialysis." Digital Reference of Ophthalmology. Accessed October 11, 2006.
  20. Brown SM. "A technique for repair of iridodialysis in children." J AAPOS. 1998 Dec;2(6):380-2. PMID 10532731.
  21. Sullivan BR. "Glaucoma, Angle Recession". eMedicine.com. August 16, 2006. Accessed October 11, 2006.
  22. Kiel J, Chen S. "Contusion injuries and their ocular effects." Clin Exp Optom. 2001 Jan;84(1):19-25. PMID 12366340.
  23. Behndig A. "Results with a modified method for scleral suturing of intraocular lenses." Acta Ophthalmologica Scandinavica. 2002 Feb;80 (1), 16-18.

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