Iris Retraction Syndrome

This 44 year-old male was hit with a shotgun shell on the right eye as a child. He had not had much in the way of medical attention. Three years prior to being seen for this examination he had a decrease in vision in the right eye. On examination his visual acuity in this eye was light perception and his intraocular pressure was 56 mmHg. On ultrasound he has a total retinal detachment with a cyst indicating a long standing detachment. He was started on aqueous suppressants and latanoprost. When he returned his intraocular pressure had dropped to 5 mmHg and his iris was markedly backbowed. The marked backbowing in this iris is characteristic of the very unusual condition called iris retraction syndrome that requires a break in the retina as well as 360 degrees of central posterior synechia. When these patients are treated with aqueous suppressants, the small amount of aqueous that is produced leaves via the break and is absorbed by the retinal pigment epithelium. The iris is pulled backwards. Campbell DG, Iris retraction associated with rhegmatogenous retinal detachment syndrome and hypotony. A new explanation. Arch Ophthalmol. 1984;102(10):1457-63.