1051: Fixing the Upside Down IOL

When we inject an IOL, we must ensure that it goes into the eye (either in the capsular bag or in the ciliary sulcus) in the correct orientation. There is the “7L” rule” which means that the leading haptic should come out of the injector with the shape of the number 7 and the trailing haptic should have the configuration of an upper case L. Once the IOL is in the eye, it is easy to determine if it has the correct orientation by remembering that S is for stupid (stupid mistake, not stupid doctor — in case someone fragile gets offended).

The 7L rule shows the correct orientation of the haptics as the IOL is inserted
S is for stupid when it comes to IOL orientation.

So now that the IOL is inside the eye upside down, how do we fix the situation? Can we leave the IOL upside down?

These important questions are answered in detail in the video shown here:


  1. Dear Dr Devgan, Once again thank you for you videos
    I wanted to point out that this rule may not apply for all IOL’s. I was assisting an ACIOL insertion (not a common occurrence) and this rule came to mind, but according to the diagram on the box the correct orientation for that particular lens was different to this (S configuration of haptics was correct). What are your thoughts from experience?

    I believe that even though this rule applies for most cases, one must be familiar with the lenses he / she is working with.

    thanks again !

  2. Do you think that the flip of the IOL in that particular direction could have forced the tip of the haptics into the bag and initiated the tear?
    I would usually rotate the lens in the opposite way, so that the haptic arms head up away from the PC. Really only works though if you still have the trailing arm still outside of the main wound.

    1. thanks for the comment and insight. looks like both haptics were above the iris during the flip. But again, hard to say with 100% certainty even with a video. The take home lesson is to get it right the first time.

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