Which medication can be a risk for intraoperative floppy iris syndrome requiring caution during cataract surgery?

• A. Latanoprost
• B. Flomax
• C. Timolol
• D. Acetazolamide

Answer: (B)

Intraoperative floppy iris syndrome is most strongly linked to certain alpha-1 adrenergic blockers used for BPH, especially the highly selective alpha-1A antagonist tamsulosin (Flomax). Tamsulosin blocks receptors in the iris dilator muscle, reducing its tone. During cataract surgery this can cause the iris to become floppy, billow, and prolapse, making pupil control and lens manipulation more difficult and increasing the risk of intraoperative complications. Because of this mechanism, caution is advised when a patient is taking tamsulosin, and surgeons plan accordingly with techniques and tools to manage a small or unstable pupil.

Latanoprost, timolol, and acetazolamide do not have the same association with IFIS, so they do not carry the same intraoperative iris risk.