Iridocyclitis - Causes, symptoms and treatment. MF.
Jun 08, 2018
Iridocyclitis is an inflammatory disease of the anterior part of the choroid of the eye, which includes the iris and ciliary body.
Causes of inflammation:
- infections( eg, influenza, tuberculosis, syphilis, herpes)
- allergy - food, drug, serum sickness
- systemic diseases of the body - rheumatism, ankylosing spondylitis
- eye trauma
- diseases of the ENT organs and oral cavity.
The etiological signs are infectious( bacteria, fungi, viruses, parasites), allergic, with systemic diseases( systemic lupus erythematosus, rheumatism, Bekhterev's disease), traumatic, and also associated with endocrine diseases and metabolic disorders.
Symptoms of iridocyclitis
Localization, depending on the prevalence of the process, distinguish iritis( inflammation of the iris), cyclitis( inflammation of the ciliary body), iridocyclitis( inflamed iris and ciliary body), keratouveitis( the anterior section of the choroid and the cornea are affected).
The course can be acute, subacute and chronic( including recurrent).
By nature of effusion, iridocyclitis is divided into serous, fibrinous, purulent, hemorrhagic.
Isolated damage to the iris or ciliary body is rare. Because of the peculiarities of the blood supply, both are affected to the same degree. Blood flow in this area is slowed, so if there is an infection in the body, it easily settles in the choroid.
Symptoms of acute iridocyclitis occur abruptly and force to consult a doctor. The patient is disturbed by severe pain in the eye, which increases with palpation, it is possible to reduce visual acuity, redness of the eye.
Diagnosis of iridocyclitis
After collection of complaints and external examination, a preliminary diagnosis can be made. To refine it, additional research methods are needed:
- visual acuity determination - may decrease with corneal edema, exudate in the anterior chamber;
- measurement of intraocular pressure - can be increased by the formation of adhesions in the iris-corneal angle or as a result of the irradiation of the pulmonary block with the development of secondary glaucoma;
- biomicroscopy - eyelid edema, pericorneal or mixed injection, corneal edema, precipitates, opalescence of the anterior chamber, hypopion - pus in the anterior chamber, hyphema - blood in the anterior chamber, iris is full, edematous, a greenish tint, a narrow, irregular pupilforms, the light is weak or lacking reaction, the posterior synechia( fusion of the iris with the lens in the pupil area), exudative film on the anterior surface of the lens and changes in the vitreous humor are possible;
- examination in transmitted light - exudate in the vitreous body;
- ophthalmoscopy - examination of the fundus is often difficult due to inflammatory changes in the anterior parts of the eye;
- ultrasound of the eye.
To determine the cause of iridocyclitis, laboratory methods of research and specialist advice are used. The doctor prescribes a general blood test( increase in the number of leukocytes, changes in the leukocyte formula, acceleration of ESR), biochemical analysis, coagulogram and rheumatic tests( change in systemic diseases), allergic tests( including intradermal for diagnosis of syphilis, tuberculosis, herpes), PCR for detectionfragments of the virus and ELISA for the determination of antibodies to this or that causative agent, radiography of the lungs and adnexal sinuses of the nose, consultations of the therapist, rheumatologist, infectious diseases specialist, allergist, dermatovenerologist.
Features of some types of iridocyclitis:
In the tubercular process of , symptoms are poorly expressed. There is no pronounced injection and pain in the eye. Patients pay attention to blurred vision, as on the endothelium of the cornea appear sebaceous precipitates, the moisture of the anterior chamber opalesces and a slurry forms in the vitreous. On the iris are formed small tubercles( tubercles), having a yellowish color. Possible complete infection of the pupil and the development of secondary glaucoma.
With the disease Behçet , iridocyclitis is characterized by a recurrent course and a purulent character. Iris is hyperemic( reddened), edematous, hypopion occurs in the anterior chamber, in the vitreous body. Rapidly forming a synechia between the iris and the lens, which leads to the development of secondary glaucoma. Each relapse is more severe than the previous one and often ends in blindness.
In heterochromic Fuchs iridocyclitis , the color of the irises of both eyes is different, more often lighter on the affected eye. Distinctive features - poorly expressed symptoms of inflammation and precipitates on the entire surface of the endothelium of the cornea, and not in the form of a triangle facing downward.
Reiter's syndrome is associated with infection with chlamydia. Characteristic triad of symptoms: iridocyclitis or conjunctivitis, urethritis and joint damage. The manifestations of inflammation of the choroid are insignificant, mainly precipitates appear on the endothelium of the cornea.
Treatment of iridocyclitis
Treatment should be possibly etiologically directed( depending on the cause the treatment is different), if the cause of the disease is known, and timely.
The following groups of drugs are prescribed:
- antibacterial, antiseptic and antiviral locally and systemically. For example, antiseptic drops( miramistin, okostistin, Sulfacyl-sodium 1 drop 6 times a day), antibacterial drops( Tobrex, Floxal, Oftakwix 1 drop 6 times a day), antiviral drops and ointments( Okoferon 1 drop 6 times a dayday or ointment of Acyclovir 3 times a day with herpetic iridocyclitis).It is also possible to administer drugs inward or in the form of injections. A good effect is observed from parabulbar injections( injection through the skin of the lower eyelid to a depth of about 1 cm towards the equator of the eye) of gentamicin.
- anti-inflammatory therapy - non-steroidal and hormonal drugs. For example, drops Indocollir, Naklof, Diclof 1 drop 3 times a day. Intramuscularly, diclofenac sodium can be administered. Steroids are topical: drops of dexamethasone( Maxidex, Oftan-dexamethasone 1 drop 3 times a day).Parabulbarno apply dexone for 0.5-1.0 ml of
- mydriatica for "gymnastics" for the pupil, in order to prevent the formation of the rear synechia. You can dig in Mesaton, Irifrin, Tropicamide, Midratsil 1 drop 3 times a day. Subcutaneously inject mezaton 1%
- antiallergic drugs - antihistamine inwards( Loratadine, Tavegil, Suprastin, Claritin, etc.)
- detoxification therapy - used intravenously drip Rheosorbylact, Hemodez, glucose solution 5% 200-400 ml once a day
- immunostimulants or immunosuppressors depending on the underlying disease
- vitamin therapy - multivitamins inside, intramuscularly, vitamins of group B, vitamin C are added to a dropper with glucose
- with inflammation with the formation of adhesions usedresorption therapy - lidase, hematase parabulbar or by electrophoresis
- in case of severe inflammation it is possible to use extracorporeal methods of detoxification - plasmapheresis, hemosorption
. Physiotherapy in the form of electrophoresis with medicinal products( mydriatica, hormones, enzymes), magnetotherapy,laser therapy, etc.
Surgical methods are used for the separation of adhesions and in the case of the development of secondary glaucoma.
Complications of iridocyclitis
Initiated and untreated iridocyclitis can lead to the development of complications: chorioretinitis, optic neuritis, secondary glaucoma, retinal detachment, atrophy of the optic apple, etc.
Ophthalmologist doctor Letyuk T.Z.