Alpha-1 blockers, especially tamsulosin, cause intraoperative floppy iris syndrome during cataract surgery: the iris billows, prolapses and the pupil constricts, raising the risk of complications. The effect can persist long after the drug is stopped, so stopping it shortly before surgery does not reliably help.
When starting an alpha-blocker in a man likely to need cataract surgery, mention the risk. More importantly, make sure the drug history reaches the ophthalmologist, who can plan pupil-expanding measures.
- Record tamsulosin and other alpha-blockers prominently in the drug history
- Advise patients to tell their eye surgeon they have ever taken tamsulosin
- Stopping tamsulosin just before cataract surgery does not remove the risk
- Consider deferring a new alpha-blocker if cataract surgery is imminent
Why it matters
Unplanned floppy iris syndrome causes avoidable cataract surgery complications.
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