Cataract Surgery, Enlarged Prostate Problems & Medication

Reviewed by:

Marc Michelson, MD, Leslie Doctor, MD

Cataract Surgery is a safe and effective procedure for removing cataracts and restoring vision. However, as with any type of eye surgery care must be taken to minimize and eliminate risks during and after surgery.

What Does My Prostate Have to Do With My Cataracts?

The prostate is an acorn shaped gland that is found below the bladder in the pelvic area of men. It actually surrounds a portion of the urethra which is the  “tube” that allows for the passing of urine. A “normal” sized prostate, one that is not enlarged, allows for the unobstructed flow of urine.

As men age the prostate gland increases in size. Generally this enlargement of the prostate does not create any sort of urinary obstruction or flow problem for men under 40 years of age. After 40 years of age the incidence of an enlarged prostate, called Benign Prostate Hyperplasia (BPH) increases significantly. The incidence of BPH is at least 50% for men at the age of 50 and rises to 80% for men in their 80’s. About 50% of all men with BPH experience some degree of urinary flow problem and 25% of men will be treated with prostate medication by the age of 80. So it is quite common.

The medications typically used to treat BPH are a type of medication called “alpha-antagonists” or “alpha blockers”. One of the more common types of “alpha blockers” prescribed is called Flomax®. Typically, on the day of Cataract Surgery your Cataract Surgeon will place one or more types of eye drops in your eye undergoing the Cataract operation in order to fully dilate or widen the Pupil of your eye. It is important to have a widely dilated Pupil so that your Cataract Surgeon can properly insert the microscopic instruments to break apart and remove the Cataract and successfully implant an intraocular lens (IOL) to restore clear vision after your eye surgery. Alpha-blockers such as Flomax®, block the Iris muscle leading to poor dilation and sometimes causing the pupil to suddenly constrict during Cataract Surgery. This potential problem that can occur during Cataract Surgery in patients using alpha-blockers, such as Flomax® is called Intraoperative Floppy Iris Syndrome (IFIS). Discontinuing these prostate medications prior to Cataract Surgery does not necessarily help.

Intraoperative Floppy Iris Syndrome (IFIS) increases the difficulty and risk of Cataract Surgery, especially if you did not tell your Cataract Surgeon that you were taking alpha-blockers.

What You Need to Know About Prostate Medication and Cataract Surgery…

If you have an enlarged prostate or BPH, there are actually many different brands of alpha-blockers your Internist or Urologist can prescribe. Generally they are considered “selective” or “non-selective” alpha-blockers. “Selective” alpha-blockers SPECIFICALLY act on the prostate and the Iris tissue and thus Cataract Surgeons need to be aware and use caution if you are taking them. These include prostate medications such as Flomax® and Rapaflo®. There appears to be no increased risk when non-selective alpha-blockers, such as Terazosin (Hytrin®), Doxazosin (Cardura®), or Alfuzosin (Uroxatral®) were taken before Cataract Surgery. Although the risk appears to be higher in patients taking Flomax® than with non-selective alpha-blockers it is important that patients inform their Cataract Surgeon if they are taking any type of alpha-blocker.

Patients should not decide on their own to discontinue their alpha-blockers without first discussing this with their Internist or Urologist.

By knowing that a patient is taking an alpha-blocker Cataract Surgeons are able to utilize different Cataract Surgery techniques and procedure modifications and achieve excellent outcomes should IFIS occur.  This makes the delay of Cataract Surgery unnecessary

The information that has been provided here is intended to give patients a basic understanding of Cataract Surgery, BPH and an enlarged prostate and how prostate medications such as alpha-blockers can make cataract Surgery difficult if they cause Intraoperative Floppy Iris Syndrome (IFIS). It is possible that your individual experience might be different. None of the information provided here is meant to be a substitute for or replace your eye doctor's consultation nor does it replace the need for you to consult with a Cataract Surgeon about specific details of Cataract Surgery and Intraocular Lens (IOL) Implantation.
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