A systematic approach to the surgical treatment of traumatic mydriasis

Purpose. To summarize the experience of treating patients with traumatic and paralytic mydriasis to optimize surgical tactics and improve treatment outcomes for these patients. Material and methods. This study included 19 patients (19 eyes),15 with traumatic mydriasis and 4 with postoperative paralytic mydriasis, who underwent surgical treatment of iris reconstruction. 4 clinical cases of surgical correction of mydriasis were described in detail. Results. Outcomes of iris surgical reconstruction defect following traumatic mydriasis depends on several factors, including the size and shape of the defect, the extent of damage to the remaining iris tissue, other eye conditions, the status of the lens and its capsule, period since the injury occurred, patient’s cosmetic preferences, and the skill and experience of the surgeon. Urrets - Zavalia syndrome, which can occur after certain ophthalmological procedures, is characterized by an enlarged pupil that fails to constrict in response to light and may require surgical correction of the iris defect. Conclusion. Surgical intervention is recommended before the onset of iris stroma atrophy to reduce surgical trauma and achieve better visual acuity and optimal cosmetic results. Implantation of an artificial iris is preferred for surgical removal of mydriasis when slit lamp examination shows a «transparent» and atrophic iris with a planar, extended posterior synechia. If the pupil diameter is 7 mm or more and/or the ultrasound biomicroscopic thickness of the iris is less than 250 µm and more than four to five months have passed since the injury, iridoplasty is not advisable due to the risk of suture eruption both during surgery and in the postoperative period. Key words: traumatic mydriasis, paralytic mydriasis, iris damage, Urrets - Zavalia syndrome