Iris Implant Surgery: Everything You Need to Know

Extreme Close-Up Of a person's Eye
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Iris implant surgery is a procedure to insert a prosthetic iris, the colored portion of the eye. Initially developed to treat people with iris defects such as ocular albinism or aniridia, it is sometimes used cosmetically to change eye color.

What Is Iris Implant Surgery?

The iris is a colored ring of muscle fibers behind the clear cornea and in front of the lens in the eye. In addition to providing eye color, the iris contracts and expands to change pupil size. This controls the amount of light that gets in to improve focus at different distances. 

Iris implant surgery is an outpatient procedure used to insert a prosthetic iris into the eye under local anesthetic. It was first developed in 1956 to repair iris defects due to congenital problems, illness, or injury. Research shows iris lens diaphragm implants help to restore working functions of the iris, including reducing glare and improving visual acuity.

Iris implants are also used for cosmetic purposes, such as changing brown eyes to blue. Cosmetic iris implants are not approved in the United States or Europe due to the risks. Americans seeking cosmetic eye color changing surgery travel out of the country to have the procedure done.

Contraindication

Artificial iris implants are contraindicated for the following:

  • Active eye infection
  • Uncontrolled inflammation of the eye
  • Eye disorders that cause the eye to be abnormal in size, shape, or function, Such as microphthalmos or rubella cataract
  • Untreated retinal detachment
  • Untreated chronic glaucoma
  • Rubeosis of the iris
  • Proliferative diabetic retinopathy
  • Stargardt's retinopathy
  • Pregnancy

Possible Risks

Functional prosthetic iris implants are designed for sulcus or intracapsular placement, while cosmetic implants are put in the anterior chamber over the iris. Complication rates are low for functional iris implants, but higher for cosmetic implants. Risks of iris implants include:

  • Reduced vision or blindness
  • Elevated pressure inside the eye that can lead to glaucoma
  • Cataracts 
  • Cornea injury leading to vision problems
  • Blurred vision and tearing due to inflammation of the iris

Purpose of Iris Implant Surgery

Iris implant surgery is used to improve vision in patients with traumatic iris defects, congenital aniridia, iris coloboma, herpetic iris atrophy, surgical iris loss, or ocular albinism.

Iris implant surgery is also a hot topic among body modification and plastic surgery enthusiasts. Iris implant surgery can be used to permanently change your eye color for cosmetic purposes. For example, bright blue eyes are a desired attribute, yet only 17% of people in the world have blue eyes.

The American Academy of Ophthalmology, the American Glaucoma Society, and the Contact Lens Association of Ophthalmologists strongly discourages people from undergoing cosmetic iris implant surgery due to the potential damage it may cause to healthy eyes.

Prosthetic iris implants used to improve visual acuity come in a few different varieties including:

  • Iris lens diaphragm
  • Endocapsular tension ring with fins
  • Customized artificial iris

Most iris implants are available in a handful of stock colors, such as blue, green, brown, and black. Patients who require surgery in one eye only may want to opt for a customized iris to better match their other eye.

Iris implant surgery is often done in combination with a cataract procedure, lens implant, or corneal transplant.

How To Prepare

For patients seeking iris implants for medical reasons, the path to surgery can be long and filled with red tape. Few doctors are credentialed to perform the surgery in the United States and there is no billing code for the procedure, meaning the surgeon cannot charge for it.

For many years, iris implants were only approved in the United States on a case-by-case basis under a compassionate use device exemption from the FDA. That changed in 2018 when the CustomFlex Artificial Iris (HumanOptics) was granted FDA approval for medical use. Made of thin, foldable medical-grade silicone, the prosthetic iris is custom-made for each individual patient.

Prior to scheduling iris implant surgery, the ophthalmologist will need to take precise measurements and photos of your eyes to order the prosthetic. Since each iris implant is custom-made, the wait can be a few months. Once the order has shipped, the surgeon's office will contact you to schedule surgery.

Cosmetic iris implant surgery is not available in the United States or Europe, though many people in search of permanently changing their eye color travel to Mexico, Panama, or Costa Rica. When engaging in medical tourism, it is crucial to do your research and check the surgeon's credentials. Traveling abroad for any cosmetic surgery can be risky and improperly performed eye surgery can result in permanent blindness.

What To Expect The Day Of Surgery

Iris implant surgery is performed as an outpatient surgery in the ophthalmologist’s office under local anesthesia. You will not be allowed to drive after the surgery, so be sure to make arrangements for a ride home.

Before the Procedure 

Once you check in to the office, you will be taken back to the procedure room and the doctor will perform a brief examination. The surgeon will place numbing drops in your eyes. Your head will be strapped into a harness to keep your head still and prevent blinking.

During the Procedure

Once the numbing drops have taken effect, the surgeon will start the procedure. If you are having other work done alongside the procedure, such as cataract surgery, the doctor will begin with that and finish with the iris implant.

To implant the iris, the surgeon makes a small incision in the cornea where it meets the sclera (white part of the eye). The silicone iris is folded and inserted through the incision. The iris is unfolded and sutured into position over the natural iris.

After the Procedure

Once the surgery is ended, your doctor will give you instructions about caring for your eye, which may include wearing dark glasses to protect against the light. You will also be prescribed eye drops to prevent infections and complications. Follow all of your doctor's instructions and call if you have any questions.

Recovery

Healing following iris implant surgery depends largely on the health of the eye prior to surgery. Most patients recover fully in a matter of weeks, provided there are no complications. Your doctor will provide guidance for when you can resume normal activities again.

Healing

Your eye may feel slightly gritty or scratchy for the first 24 to 48 hours after surgery and your vision may be blurry. Avoid touching and rubbing your eye. Your surgeon may advise you to sleep with a protective eye patch at night to avoid touching your eye.

Your eye may be slightly inflamed after the surgery which may cause slightly blurry vision for the first week or so. Your doctor will most likely ask you to come in for several follow-up visits to monitor your healing.

Permanently Changing Your Eye Color

If you are seeking to change your eye color for cosmetic reasons, there are options other than iris implant surgery. In addition to colored contacts, eye color can be permanently changed using a laser.

Eye color is made up of melanin pigment and the amount of pigment determines the shade. The procedure uses a low energy laser to disrupt the top layer of melanin on the iris for 20 to 30 seconds. This causes scavenger cells to remove tissue and over the course of about two to four weeks, a brown eye will turn blue permanently.

Although this sounds promising, the American Academy of Ophthalmologists warns the procedure carries risks of glaucoma, uveitis, and could lead to blindness.

A Word From Verywell

Iris implant surgery should only be performed by a qualified and experienced ophthalmologist. It is currently only approved for medical reasons in the United States. If you are seeking cosmetic eye color changing surgery abroad, be sure to do your research into the facility and surgeon. If not done properly, iris implant surgery can lead to complications including blindness.

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Article Sources
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  4. U.S. Food & Drug Administration. CustomFlex™ Artificial Iris - P170039. Updated June 4, 2018.

  5. Hoguet A, Ritterband D, Koplin R, et al. Serious ocular complications of cosmetic iris implants in 14 eyes. J Cataract Refract Surg. 2012;38(3):387-93. doi:10.1016/j.jcrs.2011.09.037

  6. American Academy of Ophthalmology. Cosmetic iris implants carry risk of permanent eye damage, vision loss. Updated December 29, 2014.

  7. CNN.com. Laser procedure can turn brown eyes blue. Updated March 6, 2015.