60.5 Injuries of the iris

A patient’s iris can be torn, or detached from his ciliary body, or it can herniate through a wound in his cornea or sclera. He usually has a hyphaema and other eye injuries also. Sometimes, his lens is dislocated at the same time. and you may be able to see his vitreous herniating into his anterior chamber. If his iris or ciliary body remain prolapsed in his wound, it will greatly increase the risk of infection and sympathetic ophthalmitis (60.10).

INJURIES OF THE IRIS

This extends the general method for an eye injury in Section 60.1.

If a patient’s iris has prolapsed through a corneal wound, as in J, Fig. 60-6, less than 24 hours ago, and it is clean, put it back in his eye with an iris spatula. Try to separate his iris from the rest of the wound, to prevent the formation of anterior synechiae (adhesions). This is difficult. Excision as described below is simple, and may be wiser.

If his iris is obviously damaged or contaminated, excise it. Grasp it with fine toothed forceps, draw it a little further out of the wound, and cut it with spring scissors flush with his cornea. Stroke the wound, so that the cut edges of his iris retract back. Or, gently push them back with an iris spatula. Provided there is no blood in his anterior chamber, instil atropine 1% twice daily—the atropine must be sterile.

If the cut edge of his iris bleeds, put a drop of 1/1000 adrenaline into his conjunctiva. It will control bleeding and dilate his pupil.

POSTOPERATIVELY shield the patient’s eye for three days, or until pain stops. If light disturbs him, pad both his eyes.