Complete Spontaneous Expulsion Of Iris Tissue Following Blunt Ocular Trauma

We report a rare case of traumatic aniridia in a 73-year-old man following blunt ocular trauma. The injury resulted in complete iris extrusion through a prior cataract surgery phacoemulsification wound. The patient initially presented with formed Anterior chamber with hyphema, which resolved without intervention. This case highlights the need for prompt recognition and management of post-traumatic aniridia and associated complications to optimize visual outcomes.

Case has been diagnosed and reported in a large tertiary care ophthalmology theatre, University Hospitals of Birmingham, Solihull Hospital, UK.

A 73-year-old man with Parkinson presented to the us  with sudden onset of decreased vision and ocular pain in his left eye following accidental blunt trauma caused by a fall. His medical history was significant for uncomplicated phacoemulsification surgery in the same eye 09 October 2008.

On presentation, visual acuity was reduced 5/60 in the left eye. Anterior segment examination revealed:

• 2 mm hyphema occupying the inferior anterior chamber.
• Deep A/C
• No intraocular lens dislocation.
• Flat retina

No evidence of globe rupture or posterior segment involvement was observed.

Clinical Course and Management

The hyphema resolved spontaneously over the 2 weeks with conservative management (elevation of head of bed, topical steroids, and cycloplegics). The patients vision also improved to stablise at 6/7.5. Gonioscopy revealed a total loss of iris tissue, consistent with traumatic aniridia due to expulsion of the iris through the prior surgical wound. The extruded iris tissue was no longer present, likely ejected during the initial trauma.

There was no photophobia or glare symptoms, likely due to the peripheral fibrosis of the capsular bag.

Outcome and Follow-Up

At a 6-month follow-up, the patient achieved best-corrected visual acuity (BCVA) of 6/7.5 with significant improvement in visual quality. Photophobia and glare were non-significant, and the patient reported a return to normal daily activities.

Traumatic aniridia is a rare but visually disabling consequence of blunt ocular trauma. Mechanisms include abrupt intraocular pressure spikes leading to dehiscence of surgical wounds and extrusion of iris tissue. Similar cases of iris prolapse through prior phacoemulsification wounds have been reported, emphasizing the importance of examining prior surgical sites in post-trauma cases.

Hyphema is a common initial presentation and can mask underlying iris loss. Early recognition and timely intervention, including prosthetic iris implantation, can restore visual function and improve the patient’s quality of life.