Management of retroflexion of iris – A rare sequelae following blunt trauma

Blunt ocular trauma can cause a spectrum of injuries, including rare condition like retroflexion of the iris, where the iris folds back on itself. This case report describes a 14-year-old boy who presented with defective vision in his right eye 2 months after trauma involving a blow and a stick. Examination revealed a best-corrected visual acuity (BCVA) of 20/250, traumatic cataract, inferior iris tissue loss, temporal angle recession, and superior irido-dialysis, with ambiguous findings regarding the inferior iris root. Cataract surgery with intraocular lens implantation and pupilloplasty was planned. Intraoperatively, the retroflexed inferior iris was successfully unfolded and repositioned to its anatomical position, revealing an intact iris root. Postoperatively, the patient’s BCVA improved to 20/25, with a reactive 4 mm pupil and intact iris root confirmed through follow-up imaging. This case challenges traditional views that iris retroflexion is associated with zonular rupture and highlights the role of trauma direction and pediatric anatomical factors in its pathogenesis. Unlike previously reported cases, this case demonstrated successful surgical repositioning of the retroflexed iris, emphasizing the importance of thorough preoperative assessment and meticulous intraoperative techniques. It underscores the potential for vision restoration and improved quality of life in rare and complex ocular injuries through tailored surgical intervention.