Definition

Iridodialysis is a tear at the base of the iris. It is often caused by injury or direct impact to the eye, head trauma, or accidents involving sharp objects that affect the eyeball.

The iris, which gives the eye its color, controls the size of the pupil, it can dilate or constrict the pupil. Thereby, regulating the amount of light entering the eye. In a dark environment, the pupil widens to allow more light in, while in a bright environment, it narrows to reduce light entry.

Causes

The primary cause of iridodialysis is trauma, either direct or indirect injury, that leads to the detachment of the iris from the ciliary body. This creates two pathways for light to enter the eye: through the pupil and the tear. Iridodialysis differs from cyclodialysis, where the tear occurs in the ciliary body rather than the iris. The tears can also result from eye surgery, termed iatrogenic iridodialysis.

With two entry points for light to the eyes, individuals with iridodialysis may experience double vision and increased glare.

Risk Factors

The main risk factors for iridodialysis include direct injury to the eye and head trauma.

Symptoms

Symptoms of iridodialysis can vary depending on the size of the tear:

• No symptoms in small iridodialysis
• Double vision
• Pain and glare in bright light
• Seeing flashes of light
• Presence of blood in the anterior chamber of the eye (hyphema)

In cases of eye trauma, additional symptoms may include:

• Eye pain
• Blurred vision
• History of head or eye injury

Diagnosis

Diagnosis of iridodialysis is based on clinical findings. The doctor can see any tears on the iris typically using ophthalmoscopy or slit lamp examination. The doctor will also check for other impact-related abnormalities such as lens dislocation, hyphema, eyeball rupture, and increased eye pressure.

Conditions that can mimic iridodialysis include:

• Eyeball rupture
• Retained foreign object in the eye
• Lens dislocation
• Traumatic iritis
• Corneal ulcer
• Endophthalmitis

Governance

Management of iridodialysis depends on the extent of the iris tear. Small iridodialysis may not require treatment, but other symptoms like eye anterior chamber bleeding (hyphema) or increased eye pressure will be managed accordingly. CT scans and ultrasonography (USG) may be used to rule out other diagnoses, such as foreign objects on the eye, retinal detachment, lens dislocation, and vitreous hemorrhage.

General management options of iridodialysis include:

• Bed rest and monitoring for worsening symptoms
• Wearing glasses to alleviate symptoms
• Surgery for extensive iridodialysis causing double vision, involving techniques similar to cataract surgery. This involves making a small incision on the eye, sewing the iris back into place, and then closing the incision. The techniques used will be different depending on the severity of the condition.

Complications

A major complication of iridodialysis is glaucoma, which results from increased intraocular pressure. The increased intraocular pressure will occur slowly and chronically due to disrupted eye fluid flow. This can be caused by scar tissue from the injury or tear. If left untreated, the increased intraocular pressure can damage the optic nerve, leading to visual field impairment and potential blindness.

Prevention

Since iridodialysis is related to eye injuries, the primary prevention method is to avoid such injuries. Several steps can help prevent eye injuries:

• Wear protective eyewear during activities that pose a high risk of exposure to dust, foreign objects, or flying debris to the eyes. Supervise children during these activities.
• Wear eye protection while mowing the lawn and keep children at a safe distance.
• Keep sharp objects in their designated places and out of children's reach.
• Remove slippery rugs that can increase the risk of fall. Ensure sharp furniture corners are protected to prevent injury, especially in homes with elderly individuals or children,  make sure they will not accidentally slip, fall or stumble into furniture.
• Use child car seats with secure seat belts and avoid placing children under 12 years old in the front seat of the vehicle. Secure loose objects in the car trunk.
• Avoid giving children risky toys such as toy guns, archery sets, and laser pointers that have risks to accidentally damage retina.
• Wear eye protection approved by ASTM F803 during sports involving balls, sticks, rackets, and other flying objects (shuttlecock, tennis ball, etc.). Glasses are not proven to protect your eyes from injury in sports. Professional athletes should use polycarbonate lenses with appropriate thickness (2 mm thickness for low-impact exercises and 3 mm thickness for high-impact exercises) for impact protection and helmets for certain sports (hockey, football, baseball, and lacrosse).
• Be cautious when opening bottles to avoid caps flying into your face.

When to See a Doctor?

If you experience glare and double vision after a direct impact on the eyeball, head injury, or being struck by a sharp object, seek medical attention immediately. Even minor eye injuries require prompt evaluation to prevent potential complications.

Before visiting the doctor, pay attention to these:

• Do not touch, rub, or press your eyes.
• Avoid putting any eye drops in your eyes.
• Protect your eyes with a patch that does not directly contact the eyes until you reach a health facility.
• Ask for assistance to get to the health facility safely.

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