Flomax is the brand name of the medication tamsulosin. Flomax is a medication used in men with prostate problems. Flomax has been successful in helping men with urinary retention due to prostate enlargement by relaxing the muscle inside the prostate which reduces restriction of urinary flow. When tamsulosin first came to the medical market, it seemed to be a bit of a wonder drug, but there was one complication that was figured out by Dr. David Chang of California.
Floppy iris syndrome is the term used to describe the effect Flomax® has on the iris during cataract surgery. The board certified cataract doctors and cataract surgeons at SightMD noticed this side effect years ago, but there was some time before they knew the cause. Essentially, the iris is a muscle and we depend on contraction of the iris muscle to dilate the pupil during cataract surgery so that the eye surgeon has excellent visualization. Many patients on Flomax® have initial adequate dilation and then in the middle of cataract surgery, the iris suddenly constricts and becomes floppy making cataract surgery more difficult.
As long as we know that our patients are taking Flomax®, we can prepare for floppy iris syndrome by using local injection anesthesia as well as irrigating the inside of the eye with dilating solution. There are also ways to manually dilate the pupil using iris hooks or a ring that serves the same purpose. We take the precautions that make cataract surgery as safe as possible.