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What Is Urrets-Zavalia Syndrome?

Urrets-Zavalia syndrome is a postoperative complication characterized by a fixed, dilated pupil that develops after certain eye surgeries. It was classically described after penetrating keratoplasty for keratoconus, but it can also occur after other corneal procedures and, less commonly, other intraocular surgeries. The pupil often becomes nonreactive and may be associated with iris atrophy and glare. Early recognition is important because it can be linked to pressure spikes and secondary angle-closure glaucoma.

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What Is Urrets-Zavalia Syndrome?

Urrets-Zavalia syndrome is a postoperative complication characterized by a fixed, dilated pupil that develops after certain eye surgeries. It was classically described after penetrating keratoplasty for keratoconus, but it can also occur after other corneal procedures and, less commonly, other intraocular surgeries. The pupil often becomes nonreactive and may be associated with iris atrophy and glare. Early recognition is important because it can be linked to pressure spikes and secondary angle-closure glaucoma.

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When it occurs

Symptoms typically appear in the first days to weeks after surgery. The hallmark is a persistently enlarged pupil that does not constrict normally to light. Some patients notice severe light sensitivity and blurred vision. Clinicians also look for signs of iris ischemia and postoperative pressure elevation.

Risk factors

The exact mechanism is not fully settled, but iris ischemia related to elevated intraocular pressure is a leading theory. Certain surgical and patient factors are associated with higher risk. Commonly cited factors include:

  • Penetrating keratoplasty or deep anterior lamellar keratoplasty
  • Keratoconus and other corneal dystrophies
  • Postoperative intraocular pressure spikes or retained viscoelastic
  • Use of mydriatic agents such as atropine
  • Air or gas injection in the anterior chamber in some procedures

Complications

Complications vary by severity and may involve both symptoms and secondary eye damage. Some pupils gradually improve, but many remain enlarged and irregular. Potential complications include:

  • Persistent glare, halos, and light sensitivity
  • Iris atrophy and posterior synechiae
  • Secondary angle-closure glaucoma
  • Reduced visual quality, especially in bright light

Management

Management focuses on monitoring and controlling intraocular pressure and treating any concurrent inflammation. If pressure is elevated, prompt pressure-lowering therapy is used to reduce ischemic risk and protect the optic nerve. Symptom control may include tinted contact lenses or sunglasses to reduce glare. In selected persistent cases, surgical options such as pupilloplasty may be considered to improve function and comfort.

FAQs on Urrets-Zavalia syndrome

Is Urrets-Zavalia syndrome permanent?

It can be. Some pupils partially recover, but many remain enlarged and poorly reactive, especially when iris atrophy has occurred. Symptom-focused care can still help significantly.

How soon after surgery does it show up?

It most often appears within days to 1 to 2 weeks after surgery. A new fixed dilated pupil in this window should be evaluated promptly. Early pressure checks are important.

Can it cause glaucoma?

Yes. Urrets-Zavalia syndrome can be associated with secondary angle closure and elevated intraocular pressure. Monitoring and treatment of pressure are key to protecting vision.

What helps with light sensitivity?

Tinted lenses, sunglasses, and sometimes custom contact lenses can reduce glare and photophobia. If symptoms are severe and persistent, an ophthalmologist may discuss pupil repair options. The right plan depends on pupil size and eye health.

References

Unilateral Urrets-Zavalia Syndrome After Implantable Collamer Lens Implantation: A Case Report and Review of the Literature. Journal of Medical Case Reports. https://pmc.ncbi.nlm.nih.gov/articles/PMC8456705/. Date Accessed: February 19, 2026.

Risk Factors of Urrets-Zavalia Syndrome After Penetrating Keratoplasty. Wang P, et al. https://pmc.ncbi.nlm.nih.gov/articles/PMC8911052/. Date Accessed: February 19, 2026.

Toxic Anterior Segment Syndrome and Urrets-Zavalia Syndrome: Spectrum of the Same Entity? Ganesan N, et al. https://pmc.ncbi.nlm.nih.gov/articles/PMC10062078/. Date Accessed: February 19, 2026.

Urrets-Zavalia Syndrome Following Placement of Scleral-Sutured Intraocular Lens. Sylla MM, et al. https://pmc.ncbi.nlm.nih.gov/articles/PMC10877101/. Date Accessed: February 19, 2026.

Urrets-Zavalia Syndrome After Posterior Chamber Phakic Intraocular Lens Implantation. Singh M, et al. https://pmc.ncbi.nlm.nih.gov/articles/PMC12372556/. Date Accessed: February 19, 2026.