Tamsulosin and cataract surgery: hypotonic iris

(1) Hypotonic or floppy iris syndrome has been observed during cataract surgery in patients taking tamsulosin, an alpha blocker indicated for benign prostatic hypertrophy. Hypotonic iris makes surgery more difficult and increases the risk of complications, especially those linked to the use of mechanical retractors. (2) Several studies including hundreds of patients have confirmed the role of tamsulosin in this syndrome. It is not clear how long before surgery tamsulosin should be withdrawn: cases have been reported from 2 days to 9 months after tamsulosin withdrawal. (3) It is not known whether other alpha blockers have the same effect. (4) In practice, as tamsulosin does not have a better risk-benefit balance than other alpha blockers, it should be avoided in men who have not had cataract surgery.