Editor, – The medicinal mishap by Dr Fung and Professor McCluskey (Aust Prescr 2010;33:88-9) is perhaps timely due to the increasing use of medical treatments such as tamsulosin for benign prostatic hypertrophy. Intraoperative floppy iris syndrome is well recognised in the ophthalmic community where it has particular implications in cataract surgery.
This case emphasises the need for taking a complete drug history in patients. We specifically ask patients if they have used selective alpha1adrenergic antagonists, and put a stamp on the front of the history to ensure this is not overlooked if the patient requires cataract surgery in the future.
Given that tamsulosin is prescribed by surgeons in another discipline it is important that urologists or other doctors prescribing this medication in older patients emphasise the risk it poses in cataract surgery. The potential for adverse effects from medical therapy needs to be considered in every patient. I have seen several patients on topical beta blockade for glaucoma develop such significant bradycardias that they have been considered for cardiac pacing before their drug history was properly checked. We need to be alert to the possibilities at all times to reduce the risk of harm to our patients.
Trevor Hodson
Consultant ophthalmologist
Mount Gambier, SA
