Addressing Pupillary Dilation Challenges in Phacoemulsification: Being the text of a presentation delivered during the Breakfast Symposium at the 49th Annual Scientific Conference of the Ophthalmological Society of Nigeria on 28th August 2025

Farrukh Mahmood

Authors

Farrukh Mahmood Makkah Eye Hospital, Kano, Nigeria

Abstract

Adequate pupillary dilation is a cornerstone of safe and effective cataract surgery. Small pupils increase the risk of intraoperative complications such as iris trauma, capsular tears, and corneal endothelial damage, while reducing surgical efficiency. Despite advances in phacoemulsification techniques, poor dilation remains a common and sometimes unpredictable challenge. This review summarizes the pharmacological, mechanical, and surgical strategies available to manage small pupils, with special emphasis on intraoperative floppy iris syndrome (IFIS). Practical pearls for anticipating, preventing, and addressing pupillary challenges are also highlighted to optimize patient outcomes.

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