Tamsulosin and floppy iris syndrome in benign prostatic hyperplasia patients

The American Society of Cataract and Refractive Surgery have cautioned ophthalmic surgeons of a new, sporadic problem associated with the pupil during cataract surgery in patients who are taking tamsulosin. The rare syndrome has been christened as intraoperative floppy iris syndrome (IFIS) by ophthalmologists. IFIS is characterised by subnormal preoperative pupil dilation and repeated intraoperative prolapse of a billowing, floppy iris in patients taking tamsulosin hydrochloride. Tamsulosin is the most commonly prescribed alpha-blocker for the treatment of benign prostatic hyperplasia in the ageing male population. Surprisingly, IFIS is not manifested in patients taking other alpha-blockers, such as terazosin, doxazosin or prazosin. The aetiology of IFIS with tamsulosin principally involves pharmacological mechanisms. Furthermore, there could be confounding factors (other than potency and selectivity of alpha-blockers for alpha(1)-adrenoceptors) that might be responsible for the association of IFIS with tamsulosin. IFIS will obviously have clinical implications in cataract surgery of benign prostatic hyperplasia patients with a medical history of tamsulosin use.