Acquired police

Specialty: Ophthalmology.

• recently appearing multiple pupils
• multiple holes in the iris

Why it occurs

• High-energy penetrating or blunt ocular trauma resulting in tearing, iridodialysis, or dialysis of the iris root
• Sequence of previous surgical iridectomies or multiple peripheral iridotomies performed with Nd:YAG laser for narrow-angle glaucoma
• Essential iris atrophy (Chandler syndrome or iridocorneal endothelial syndrome, which causes pupillary distortion and stretch holes)
• Tumor necrosis of the iris (iris melanoma with erosion and perforation of the stroma)
• Necrotizing intraocular infections (severe herpetic uveitis with focal necrosis of the iris)

Initial workup

Slit lamp biomicroscopic examination with direct illumination and backlighting to examine the integrity of the iris stroma; Angular gonioscopy to evaluate the existence of peripheral anterior synechiae; Measurement of intraocular pressure using Goldmann tonometry; Previous Segment Optical Coherence Tomography (OCT-SA) to assess the iris openings and the angular relationship with the lens.

Standard management

• There are no eye drops to reverse structural holes in the iris. Pharmacological treatment is aimed at modulating intraocular pressure if secondary glaucoma exists. Dorzolamide — 2% eye drops, 1 drop every 12 hours to reduce the synthesis of aqueous humor
• Timolol — 0.5% eye drops, 1 drop every 12 hours
• Correction of accessory pupils is performed surgically through pupilloplasties with intraocular sutures or through the aesthetic use of prosthetic cosmetic contact lenses with a painted pupil to mitigate secondary monocular diplopia.