OPHTHALMOLOGY
Some drug classes can increase risk of floppy iris syndrome
Alpha-1 blockers, atypical antipsychotics and some antidepressants were linked with an increased incidence of the eye condition, particularly in women, according to a Canadian study
April 21, 2025
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Alpha-1 blockers, atypical antipsychotics and tricyclic antidepressants were associated with an increased incidence of intraoperative floppy iris syndrome, according to a study from University of Ottawa, Canada.Imipramine, a tricyclic antidepressant, demonstrated the strongest association, according to the authors, with brinzolamide and salbutamol disproportionately associated with the risk for the condition in women.The authors conducted a population-based pharmacovigilance study to identify drugs most strongly associated with the incidence of floppy iris syndrome and explore sex-based differences in these associations.The study used data from the US Food and Drug Administration between 2003 and 2024 and evaluated the association between more than 20,000 drugs and the incidence of floppy iris syndrome.In this study, alpha-1 blockers, tricyclic antidepressants, atypical antipsychotics, carbonic anhydrase inhibitors, corticosteroids, 5-alpha reductase inhibitors, beta-blockers, prostaglandin analogs and beta-2 agonists were linked to cases of floppy iris syndrome.Imipramine demonstrated the highest disproportionate association with the incidence of floppy iris syndrome, followed by tamsulosin, an alpha-1 blocker, and chlorpromazine, an atypical antipsychotic.Use of brinzolamide, a carbonic anhydrase inhibitor, and salbutamol, a beta-2 agonist, was disproportionately associated with the incidence of floppy iris syndrome among women but not among men.The study was published recently in the American Journal of Ophthalmology.