• Cataract/Anterior Segment, Comprehensive Ophthalmology

    Management of Posterior Synechiae Causing Small Pupil

    Small pupil may be encountered with posterior adhesions (synechiae) between the iris and the crystalline lens. As isolated pathology, it is usually a result of long-term use of miotics, pseudoexfoliative syndrome, or neurological disorders. Posterior synechiae is a result of uveitis, acute angle closure glaucoma, ocular trauma, or previous surgery. Removal of a cataract through such a pupil is challenging. The situation is recognized preoperatively by failure to achieve dilation after instillation of mydriatics such as cyclopentholate 1%, tropicamide 0.5%, and phenylephrine 10%. Posterior synechiae may be released before surgery following subconjunctival injection of Mydricaine. Patients using miotics are advised to discontinue them 3 weeks before surgery.