Iridodialysis

Iridodialysis is the detachment or avulsion of the iris from its attachment to the ciliary body at the iris root. It most often results from blunt ocular trauma but can occur with penetrating injuries or as an intraoperative or postoperative complication. The detached iris tissue typically forms a peripheral crescent-shaped area that may be visible at the limbus on examination, and the pupil may appear irregular.

Causes and pathophysiology: The injury disrupts the iris root attachment to the ciliary body, allowing iris tissue to be pulled away from the rest of the eye. Related injuries from trauma, such as hyphema or angle recession, are common and can increase the risk of secondary glaucoma. The extent of detachment varies and can influence symptoms and treatment options. Small or asymptomatic iridodialyses may have little impact, while larger ones can cause cosmetic distortion and functional problems.

Clinical features and diagnosis: Patients may report glare, photophobia, or visual disturbances after trauma. On slit-lamp examination, a crescentic dark area of iris tissue at the limbus may be observed, with an irregular or deviated pupil. Gonioscopy assesses the anterior chamber angle, and imaging such as ultrasound biomicroscopy can delineate the extent of iris-root separation. Intraocular pressure should be monitored due to the risk of secondary glaucoma from associated angle damage.

Management and prognosis: Management depends on size and symptoms. Small, asymptomatic iridodialyses may be observed with treatment of any concomitant injuries. Large or visually significant iridodialyses, or those causing marked iris irregularity, often require surgical repair to reattach the iris root to the ciliary body or sclera using sutures. Postoperative prognosis is influenced by the extent of trauma and the development of glaucoma or synechiae; timely repair can improve cosmetic and functional outcomes.