Preoperative use of atropine to prevent intraoperative floppy-iris syndrome in patients taking tamsulosin

Intraoperative floppy-iris syndrome (IFIS) is a recently identified condition associated with phacoemulsification in patients using the α1-antagonist tamsulosin (Flomax). Patients with IFIS manifest a triad of symptoms during cataract surgery: fluttering and billowing of iris stroma due to normal fluid movement, propensity of iris prolapse to phaco and side-port incisions, and progressive constriction of the pupil. Prevention of IFIS by withdrawing tamsulosin preoperatively has not shown consistent benefit. We describe the preoperative administration of atropine, which effectively prevented the occurrence of IFIS in patients receiving tamsulosin.