Iris Prolapse in Pediatric Corneal Trauma: Emphasizing the Role of Emergency Recognition and Rapid Referral

IntroductionPediatric ocular trauma represents a significant cause of preventable blindness worldwide and constitutes an important proportion of emergency department visits (1,2). Among these injuries, corneal perforation accompanied by iris prolapse is particularly vision-threatening, as it can rapidly lead to infection, anterior chamber instability, and permanent visual impairment if not promptly managed (3-6). The aim of this report is to highlight the clinical importance of iris prolapse in children and emphasize the critical role of early recognition and rapid surgical intervention.Case An 8-year-old boy presented to the emergency department with acute pain, redness, and decreased vision in the left eye following blunt ocular trauma caused by a stone. Ophthalmic examination revealed a full-thickness corneal perforation at the 15:00 limbal position, complicated by iris prolapse and fibrin reaction in the anterior chamber. The patient underwent urgent surgical intervention under general anesthesia. Using viscoelastic-assisted techniques, the prolapsed iris was gently repositioned into the anterior chamber, followed by meticulous corneal suturing and conjunctival closure. Postoperative recovery was uneventful, with restoration of anterior chamber depth, stable wound healing, and preservation of viable iris tissue.ConclusionThis case highlights the rarity and clinical significance of iris prolapse in pediatric ocular trauma. Rapid diagnosis, emergency referral, and modern tissue-preserving surgical techniques such as viscoelastic-assisted iris repositioning can successfully restore globe integrity and minimize long-term sequelae. Effective collaboration between emergency physicians and ophthalmologists is essential to prevent irreversible visual loss in this vulnerable population (7-10).REFERENCES1. Al Mahmoud T, Al Hadhrami F, Al Lawati T, et al. Epidemiology of pediatric ocular trauma in a tertiary hospital: a 5-year retrospective review. BMC Ophthalmol. 2022;22(1):301. doi:10.1186/s12886-022-02519-02. Soliman MM, Eldaly MA, Ghanem AA. Pediatric ocular trauma in Upper Egypt. Clin Ophthalmol. 2021;15:2543-51. doi:10.2147/OPTH.S3114373. Zhou Y, Song X, Li Y, et al. Clinical characteristics and visual outcomes of pediatric corneal perforation. Graefes Arch Clin Exp Ophthalmol. 2020;258(6):1259-66. doi:10.1007/s00417-019-04585-74. Knyazer B, Bilenko N, Levy J, et al. Open globe eye injury characteristics and prognostic factors in Southern Israel: a retrospective epidemiologic review of 10 years’ experience. Isr Med Assoc J. 2019;21(7):466-70. PMID:313900655. Shah MA, Shah SM, Patel KD, et al. Ocular trauma in children: a tertiary eye care center study. Clin Ophthalmol. 2022;16:3267-75. doi:10.2147/OPTH.S3827606. Cagini C, Fiore T, Lupidi M, et al. Management of iris prolapse in traumatic corneal injuries: surgical strategies and outcomes. Eye (Lond). 2023;37(2):345-52. doi:10.1038/s41433-022-02365-87. Moussa G, Yassin M, Elgin C. Emergency management of corneal perforations in pediatric patients: outcomes of early surgical repair. Am J Ophthalmol Case Rep. 2021;22:101023. doi:10.1016/j.ajoc.2021.1010238. Yıldırım R, Demirci G, Akova YA. Viscoelastic-assisted reposition of prolapsed iris tissue in corneal perforations: clinical outcomes. Turk J Ophthalmol. 2022;52(3):183-9. doi:10.4274/tjo.galenos.2022.815059. Batur M, Seven E, Duman S. Management of traumatic corneal injuries with tissue adhesives and sutures. Turk J Ophthalmol. 2019;49(3):142-8. doi:10.4274/tjo.galenos.2019.9404410. Vassallo J, Canning J, Dziadkowiec O, et al. Patterns and outcomes of ocular trauma presenting to the emergency department: a 10-year analysis. Emerg Med J. 2021;38(5):368-73. doi:10.1136/emermed-2020-209775