Performing pupil stretching is safe, easy, and effective but there is a delicate balance. Too forceful of a stretch can cause iris damage at the pupil margin and may result in a noticeable cosmetic deformity especially in light colored irides. In addition, stretching a pupil in a patient with floppy iris syndrome from tamsulosin (Flomax) use may make the iris more floppy. While this patient does not have a very small pupil, I still want to enlarge it to facilitate removal of the cataract. With a single pupil stretch using a hook and a chopper, I am able to enlarge the pupil to about 5 mm in diameter. Then the capsulorhexis can be at least that size or even slightly bigger. I also use the iris and pupil to hold the nucleus as I chop and emulsify. Full case shown start to finish.
