Pupil Ovalization

• Commonly associated with haptic misplacement.
• Can be a complication of anterior chamber IOLs, especially in eyes with oversized angle-supported AC IOLs or secondary to iris tuck.

Clinical Features

• Usually asymptomatic, but in certain cases may cause significant symptoms of night glare, halos or diplopia.
• Signs:
• The axis of the pupillary distortion usually coincides with the major axis of the AC IOL
• Chronic haptic loop compression against the iris root could induce ischemic and inflammatory changes as well as sector iris atrophy.

Management

• Correct positioning of the haptics and precise measurement of limbus-to-limbus diameter are essential for an optimal surgical result.
• Topical steroids may be appropriate for inflammation reaction.
• IOL explantation may be required in cases with severe symptoms and compromised anterior chamber structures that cause uveitis, glaucoma, hyphema (UGH) syndrome, corneal endothelial loss or pseudophakic bullous keratopathy.