Which of the following methods of pupil enlargement is least effective for poor dilation due to Flomax:

  1. Intraocular epinephrine
  2. Iris hooks
  3. Healon 5
  4. Manual iris stretching

Correct Answer: Manual iris stretching

Manual stretching of the iris (i.e., with 2 Kuglen hooks, etc.) works poorly in patients with small pupils due to Flomax and may make the iris more “floppy” intraoperatively.

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