Management of Traumatic

Iridodialysis with Hyphaema

CHAIRMAN
Dr. Khair Ahmed Choudhury
Associate Professor
NIO&H
MODERATOR
Dr. Nusrat Shahrin
PRESENTOR
Dr. Syed Nabil Bin Maruf
HMO
 IRIDODIALYSIS

Sometimes referred to as COREDIALYSIS

Dehiscence / Disinsertion / Separation of the Iris

from the Ciliary Body
at its Root
 SCLERAL SPUR

 Most anterior projection of SCLERA

 Protrudes into the AC at the ANGLE

 Underlies the POSTERIOR BORDER of SURGICAL

LIMBUS, 1mm behind BLUE ZONE
 Gonioscopically:

• Narrow, whitish annular ridge that yellows

with age

• Immediately posterior to the TRABECULUM

• Just anterior to the CILIARY BODY

 Traumatic Iridodialysis with Hyphaema
 Presents with:

 History of BLUNT TRAUMA

 PAIN

 BLURRING / LOSS of VISION / NO VISUAL

DISTURBANCE

 DIPLOPIA, GLARE, PHOTOPHOBIA

 D-Shaped PUPIL, Corectopia with poor
light reaction

 Associated conjunctival congestion,

subconjunctival haemorrhage, corneal
edema, traumatic cataract, sublaxated or
dislocated lens, posterior segment injuries
with external swelling

 IOP Raised or Lowered

The Complaints & Findings of the patient will
largely depend upon the Nature of Hyphaema
 HYPHAEMA

 Haemorrhage in the AC

 Ranges from MICROSCOPIC to occupying

the ENTIRE AC

 Source:
 IRIS ROOT

 CILIARY BODY FACE

GRADING of HYPHAEMA
 INVESTIGATIONS
Generally directed towards detection of:

POSTERIOR SEGMENT injuries : B-Scan

ORBITAL or CRANIAL / INTRACRANIAL injuries :

Cranial CT-Scan

BLEEDING DISORDERS or BLOOD DYSCRASIAS : CBC,

PBF, BT, CT, PT, Hb-Electrophoresis

SURGICAL FITNESS : RBS, ECG

 TREATMENT
Iridodialysis covered by Upper Lid

Surgical Repair of Iridodialysis is NOT required

General –

 Bed Rest, Sedation, with Head Elevation

 Avoidance of any Anti-Coagulants

 Close observation with frequent follow-ups till complete

resolution for complications
Medical -

 Topical/Systemic Anti-Glaucoma drugs:

Topical β-blockers or α-agonists
Systemic CAIs

 Atropine E/D

 Topical corticosteroids
AC Paracentesis indications:

 Risk of corneal stromal blood staining

 Severe visual impairment

 Hyphaema does not decrease to <50% by 8 d

 IOP>60 mmHg for 48 hrs

 IOP>25 mmHg with total hyphaema for >5 d

 IOP>24 mmHg for >24 hrs in dyscrasia patients

 Iridodialysis with Diplopia & Glare

Surgical Repair of Iridodialysis with

AC Paracentesis

Basic Principle of Iridodialysis Repair

Attachment of the Disinserted Iris Root with the

Scleral Spur
SCLERAL POCKET TECHNIQUE using
MCCALLEN SUTURE
SEWING MACHINE
TECHNIQUE
 OTHERS

 Goldfeder Sutureless Technique

 Iridencleisis Technique

 Hang Back Technique

 Stroke & Dock Technique

THANK
YOU