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Flomax and Cataract Surgery

August 12, 2008

Flomax is the most commonly prescribed drug to treat prostate enlargement, or benign prostate hyperplasia (BPH). Flomax and other drugs in the alpha-blocker class decrease the need to urinate in the middle of the night.

Flomax does not adversely affect the eye or vision, but it does adversely affect cataract surgery by preventing the pupil to adequately dilate during the procedure. This condition has been coined Intraoperative Floppy Iris Syndrome (IFIS).

IFIS has been associated with an increased complication rate during cataract surgery. It is very important for the patient to advise their ophthalmologist that they are taking Flomax if they are to undergo cataract surgery. In my practice, I take the following steps to insure an excellent surgical outcome:

  • Discontinue Flomax several weeks prior to surgery, if possible.
  • Prescribe a long acting dilating drops 1 week prior to surgery.
  • Use a dilating medication in the eye during surgery.
  • Use a new device called the Malyugin Ring during cataract surgery in order to ensure adequate pupil dilation.

The Malyugin ring has been one of the most important inventions in preventing complications associated with IFIS. It makes a possibly difficult case much easier by mechanically keeping the pupil dilated during surgery. I am suprised that more ophthalmic surgeons are not using this device.


Recent television commercials touting the effectiveness of Flomax state the following warning: “Flomax is an excellent prostate medication, and there is no need for patients to avoid it or stop taking it out of concern over eye problems. However, the key is for patients to inform their ophthalmologist when they are taking this or any other prostate drugs prior to eye surgery.”

I will add some controversary to this post by suggesting that any patient who is about to be prescribed Flomax see their ophthalmologist before starting Flomax. If even a small cataract is noted, I would advise its removal before starting the Flomax. I am convinced this will lead to a much safer surgical outcome!

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