A well-dilated pupil facilitates cataract surgery and if the patient has a small pupil there are multiple options for safely completing the case. We have reviewed the techniques of pupil stretching, using iris hooks, and even prolapsing the nucleus into the iris plane. We want to avoid struggling during cataract surgery because of a smaller pupil.
The Malyugin ring is a plastic device that is used to temporarily stretch and expand the pupil during cataract surgery. It is then removed at the end of the surgery to return the pupil to the normal state. Remember that the total amount of pupil stretching and iris trauma is about the same for pupil stretching, iris hooks, or pupil expansion rings. Seeing a little bleeding from the pupil margin is not unusual.
