Iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away

Avulsion

Avulsion in general refers to a tearing away. Specifically, it can refer to:* A type of amputation where the extremity is pulled off rather than cut off* Avulsion fracture* Avulsion injury, the removal of all the layers of skin from abrasion...

 of the iris

Iris (anatomy)

The iris is a thin, circular structure in the eye, responsible for controlling the diameter and size of the pupils and thus the amount of light reaching the retina. "Eye color" is the color of the iris, which can be green, blue, or brown. In some cases it can be hazel , grey, violet, or even pink...

 from its attachment to the ciliary body

Ciliary body

The ciliary body is the circumferential tissue inside the eye composed of the ciliary muscle and ciliary processes. It is triangular in horizontal section and is coated by a double layer, the ciliary epithelium. This epithelium produces the aqueous humor. The inner layer is transparent and covers...

.

Causes

Iridodialyses are usually caused by blunt trauma

Blunt trauma

In medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma...

 to the eye

Human eye

The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...

, but may also be caused by penetrating eye injuries

Eye injury

Physical or chemical injuries of the eye can be a serious threat to vision if not treated appropriately and in a timely fashion. The most obvious presentation of ocular injuries is redness and pain of the affected eyes. This is not, however, universally true, as tiny metallic projectiles may cause...

. An iridodialysis may be an iatrogenic complication of any intraocular surgery and at one time they were created intentionally as part of intracapsular cataract extraction.
Iridodialyses have been reported to have occurred from boxing

Boxing

Boxing, also called pugilism, is a combat sport in which two people fight each other using their fists. Boxing is supervised by a referee over a series of between one to three minute intervals called rounds...

, airbag

Airbag

An Airbag is a vehicle safety device. It is an occupant restraint consisting of a flexible envelope designed to inflate rapidly during an automobile collision, to prevent occupants from striking interior objects such as the steering wheel or a window...

 deployments, high-pressure water jets, elastic bungee cord

Bungee cord

A bungee cord , also known as a shock cord, is an elastic cord composed of one or more elastic strands forming a core, usually covered in a woven cotton or polypropylene sheath...

s, bottle cap

Bottle cap

Bottle caps are a type of closure used to seal the openings of bottles of many types. They can be small circular pieces of metal, usually steel, with plastic backings, and for plastic bottles a plastic cap is used instead. A bottle cap is typically colorfully decorated with the logo of the brand...

s opened under pressure, water balloon

Water balloon

A water balloon or water bomb is a latex rubber balloon filled with water. They are commonly used in water balloon fights and as a practical joke device.-History:...

s, fireworks

Fireworks

Fireworks are a class of explosive pyrotechnic devices used for aesthetic and entertainment purposes. The most common use of a firework is as part of a fireworks display. A fireworks event is a display of the effects produced by firework devices...

, and various types of ball

Ball

A ball is a round, usually spherical but sometimes ovoid, object with various uses. It is used in ball games, where the play of the game follows the state of the ball as it is hit, kicked or thrown by players. Balls can also be used for simpler activities, such as catch, marbles and juggling...

s.

Symptoms and signs

Those with small iridodialyses may be asymptomatic

Asymptomatic

In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...

 and require no treatment, but those with larger dialyses may have corectopia

Corectopia

Corectopia is the displacement of the eye's pupil from its normal, central position. It may be associated with high myopia or ectopia lentis. Medical or surgical intervention may be indicated for the treatment of corectopia.-See also:*Eye injury...

 or polycoria

Polycoria

Polycoria is a pathological condition of the eye characterized by more than one pupillary opening in the iris. It may be congenital or result from a disease affecting the iris....

 and experience monocular diplopia, glare

Glare (vision)

Glare is difficulty seeing in the presence of bright light such as direct or reflected sunlight or artificial light such as car headlamps at night. Because of this, some cars include mirrors with automatic anti-glare functions....

, or photophobia

Photophobia

Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical photosensitivity of the eyes, though the term...

. Iridodialyses often accompany angle recession and may cause glaucoma

Glaucoma

Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

 or hyphema

Hyphema

Hyphema is blood in the front chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea.-Causes:...

. Hypotony

Intraocular pressure

Intraocular pressure is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk from glaucoma...

 may also occur.

Treatment and management

Iridodialysis causing an associated hyphema has to be carefully managed, and recurrent bleeds should be prevented by strict avoidance of all sporting activities. Management typically involves observation and bed rest

Bed rest

Bed rest is a medical treatment involving a period of consistent recumbence in bed. It is used as a treatment for an illness or medical condition, especially when prescribed or chosen rather than resulting from severe prostration or imminent death...

. Red blood cells may decrease the outflow of aqueous humor, therefore the eye should be kept soft by giving oral acetazolamide

Acetazolamide

Acetazolamide, sold under the trade name Diamox, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, Idiopathic intracranial hypertension , altitude sickness, cystinuria, and dural ectasia...

. Accidental trauma during sleep should be prevented by patching with an eye shield during night time. Avoid giving aspirin, heparin/warfarin and observe daily for resolution or progression. A large hyphema may require careful anterior chamber washout. Rebleeds may require additional intervention and therapy.

Later, surgical repair may be considered for larger avulsions causing significant double vision, cosmesis or glare symptoms. Surgical repair is usually done by 10-0 prolene suture taking the base of iris avulsion and suturing it to the scleral spur

Scleral spur

The scleral spur is an annular structure in the human eye, a protrusion of the sclera into the anterior chamber. It is the origin of the longitudinal fibres of the ciliary muscle and is attached anteriorly to the trabecular meshwork....

 and ciliary body junction.

Complications

Those with traumatic iridodialyses (particularly by blunt trauma) are at high risk for angle recession

Glaucoma

Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

, thereby causing increased intraocular pressure

Intraocular pressure

Intraocular pressure is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk from glaucoma...

 (IOP). This is typically seen about 100 days or three months after the injury, and is thereby called 100 day Glaucoma. Medical or surgical treatment to control the IOP may be required if glaucoma is present. Soft opaque contact lens

Contact lens

A contact lens, or simply contact, is a lens placed on the eye. They are considered medical devices and can be worn to correct vision, for cosmetic or therapeutic reasons. In 2004, it was estimated that 125 million people use contact lenses worldwide, including 28 to 38 million in the United...

es may be used to improve cosmesis

Cosmesis

Cosmesis is the preservation, restoration, or bestowing of bodily beauty. In the medical context, it usually refers to the surgical correction of a disfiguring defect, or the cosmetic improvements made by a surgeon following incisions...

and reduce the perception of double vision.

Images

• "Cornea & External Diseases: Trauma: Traumatic Iridodialysis." Digital Reference of Ophthalmology. Accessed October 11, 2006.
• "Glaucoma: Angle Closure: Traumatic Iridodialysis." Digital Reference of Ophthalmology. Accessed October 11, 2006.