Sir,

I would like to comment on the above correspondence by Ünal et al.1 The authors conclude that ‘discontinuation of chlorpromazine might be a wise course of action before cataract surgery to avoid the possibility of IFIS’. I feel that such advice should not be given on the basis of a single anecdotal report.

Intraoperative floppy iris syndrome (IFIS) is characterised by subnormal preoperative pupil dilation, repeated intraoperative prolapse of a billowing, floppy iris, and progressive intraoperative miosis.2 It was originally suggested that this was specific to patients on tamsulosin and not to other alpha blockers, however this and other reported cases suggest that IFIS may occur with all commercially available alpha-blockers (alfuzosin, doxazosin, tamsulosin and terazosin).3 Osher4 suggests that IFIS is a form of iris dystonia which can result from many different causes, one of which is flomax (tamsulosin), and can occur in both sexes with a highly variable degree of susceptibility and severity. IFIS may even occur without any identifiable causative factor.

Here, many questions spring to mind: why did this patient present with cataract at age 48. Had there been other significant disease, trauma or treatment? Was this a first or second eye operation? What was the experience with the other eye? Why did the patient require a general anaesthetic? Were there other factors expected to cause difficulties? What other medications had the patient used? Having been diagnosed with schizophrenia over 29 years ago the patient must have been exposed to various medications linkable to IFIS.

In conclusion I do not think it is wise to advocate cessation of chlorpromazine before cataract surgery. There is no mention of the risks attached to stopping a medication especially when it is used in controlling mental illness beyond most ophthalmologists area of expertise. Chlorpromazine is not an uncommon drug and has been in use for many years without prior report of this effect.