Heterochromia Iridis Cataract Surgery

Heterochromia iridis is a condition where there are two different iris colors, usually one eye being darker than the other. Sectoral heterochromia iridis is when a sector or part of one iris has a different color than the rest of it.

This patient is scheduled for routine cataract surgery and there is no significant effect from the sectoral heterochromia iridis during the procedure.

This is a routine case which is quite efficient. There are no wasted movements and critical steps such as the capsulorhexis and the removal of the cataract nucleus are done in a smooth and controlled manner.

For the young ophthalmologists who are learning cataract surgery, pay attention to the small details such as the proper draping of the lashes, the way that the eye stays in primary position, how the instruments float within the incision without distorting it, and how the fluidics allow cataract material to flow into the aspiration port.

For more advanced surgeons in training, pay attention to the first chop where the cataract nucleus is divided into two halves. This first chop is the key to efficient nucleus removal with minimal phaco energy and a large margin of safety.

While this patient has benign heterochromia iridis, keep in mind that there are other causes which can be either congenital or acquired.

Congenital heterochromia iridis can be associated with Waardenburg syndrome, Sturge-Weber syndrome, neurofibromatosis, Horner’s syndrome, and more.

Acquired heterochromia iridis can be found with trauma, prior ocular surgery, pigment dispersion syndrome, blood staining from hyphema, prostaglandin glaucoma medications, Fuch’s heterochromic cyclitis, retained metallic foreign body, glaucomatocyclitic crisis, and ocular melanoma which can be life threatening due to metastases.

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