Immediate management of iris and lens in perforations of the eye

Once accurate corneo-scleral repair has become the rule, the management of associated iris and lens damage can be improved. Much more effective primary surgical repair has been established with the aim of preventing complications and the extra hazards of a difficult secondary procedure. Adequate examination of the injured eye is essential. Much may be obscured at the initial examination. There should be no hesitation in dilating the pupil as this will permit a more satisfactory assessment of the extent of damage behind the iris diaphragm. Before commencing surgery, it must be established whether the lens is damaged or not. Hypotony and fibrin on the lens surface can both cause an appearance suggestive of cataract. Lens surgery is needed at the primary repair only when the capsule is torn.