Letters Lower urinary symptoms in men

Older men: cataracts v prostates

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c3446 (Published 29 June 2010) Cite this as: BMJ 2010;340:c3446
  1. Lucy L J Howe, consultant ophthalmic surgeon1
  1. 1Dorset County Hospital NHS Foundation Trust DT1 2JY
  1. lucy.howe{at}dchft.nhs.uk

    Recent National Institute for Health and Clinical Excellence guidelines for management of lower urinary tract symptoms in men recommend α blockers for moderate to severe urinary symptoms.1 2 Ophthalmic surgeons have long been concerned about the potentially deleterious effects of α blockers on cataract surgery. Intraoperative floppy iris syndrome (IFIS) occurs in about 3% of cataract extractions3 and is strongly correlated with systemic use of α blockers, particularly tamsulosin. The syndrome consists of poor pupillary dilation, progressive intraoperative miosis with billowing of the iris, and increased risk of iris prolapse through the corneal sections. IFIS is associated with increased risks of surgical complications.4 Steps can be taken during surgery to reduce complication risks if a history fof previous or current α blocker use has been elicited. Concerns about IFIS are such that α blocker use is included in the preanaesthetic questions of the cataract surgical safety checklist.5

    The Royal College of Ophthalmologists expressed concern to the Medicines and Healthcare products Regulatory Agency that tamsulosin has been reclassified as a pharmacy rather than prescription drug. Ophthalmologists must be vigilant in eliciting a history of α blocker use when assessing men for cataract surgery and be aware of over the counter preparations. The deleterious effects of α blockers on cataract surgery can persist for years after discontinuation so they should not be discontinued before intraocular surgery. Routine screening of men for cataracts before starting α blockers is impractical,4 but the likelihood of upcoming intraocular surgery should be considered before prescribing α blockers, particularly tamsulosin, for lower urinary tract symptoms in men.


    Cite this as: BMJ 2010;340:c3446


    • Competing interests: None declared.


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