Iridocyclitis( anterior uveitis): symptoms and treatment
Mar 05, 2018
Iridocyclitis, or anterior uveitis, is a rather serious disease of the organ of vision, which is an inflammation of the choroid of the eye.It complicates the course of many infections, is relatively difficult to treat and often leads to persistent loss of vision.Table of contents: Anatomy of the choroid of the eye Causes of iridocyclitis Symptoms of iridocyclitis Diagnosis of anterior uveitis Treatment of iridocyclitis
Anatomy of the choroid of the eye
One of the membranes of the eye is called vascular.It is divided into three departments:
- iris( iris);
- ciliary( otherwise - ciliary) body( corpus ciliare);
- itself choroid( chorioidea).
The first two departments are inextricably linked, forming a single network.Thus, the iris and ciliary body are supplied from one source and innervated by the first branch of the trigeminal nerve, while the choroid is fed by vessels from other arteries, and there are no nerve endings at all.
This is why isolated inflammations of the iris( iritis) and the ciliary body( cyclite) are extremely rare.Most often, with the defeat of one of the departments, the second suffers immediately.
Causes of Iridocyclitis
A special feature of the blood vessels of the choroid is a wide lumen of the capillaries, a slow flow of blood through them and the presence of a kind of "windows" in the wall of the capillaries.These factors contribute to the emergence of conditions under which the damaging agent( poison, microorganism, immunocomplex, tumor cells) can easily penetrate the vessel wall, causing a local reaction.
Factors leading to inflammation in the anterior chamber of the eye are conventionally divided into two groups:
- Endogenous factors are what affects the eye "from within" the body.This includes:
- infections - viral, bacterial, protozoal, fungal, rickettsial and so on;
- systemic autoimmune and rheumatic diseases - rheumatism, rheumatoid arthritis, ankylosing spondylarthrosis, etc.;
- endocrine disorders;
- Exogenous factors are what amaze the eye from the outside.This includes:
- surgical interventions;
- exposure to toxic substances, etc.
The vast majority of iridocyclitis is due to endogenous factors, that is, they are either a complication of already existing diseases, or a form of their course.
Symptoms of iridocyclitis
Usually patients who are "taught" by the Internet, consult a doctor 2-3 days after the onset of the disease.At first they think that they have conjunctivitis, which they are trying to treat with well-known albucid, tea brew and chamomile infusion.Only after a day or two, a drop in vision is detected, and the person goes to the ophthalmologist.
Complaints arise from the first day.The patient usually talks about pain in the eye, his redness, lacrimation, photophobia, deterioration of vision.Pressing on the eyeball is very painful.
Objectively, even with the naked eye you can see a change in the color of the iris, a clouding of the moisture in the anterior chamber of the organ of vision.The narrowing of the pupil and the absence or decrease in its response to light.The shape of the pupil often becomes incorrect due to the formation of adhesions( synechiae), which hold its edges, preventing them from dispensing.In neglected cases, the pupil can completely overgrow completely.
On examination, the accumulation of pus in the lower part of the anterior chamber( hypopion) can be seen, precipitates( clumps of glued cells) can be detected.The latter serve as indicators of the intensity of inflammation.
Diagnosis of anterior uveitis
In the diagnosis of iridocyclitis, it is important to have a correct history. The doctor finds out everything about:
- time of onset of the disease;
- single or double-sided lesions;
- factors that contribute to the intensification of the inflammatory reaction( smoking, hypothermia, stress, drunkenness, exacerbation of systemic pathology);
- recently suffered diseases, which could cause the iridocyclitis;
- possible contacts with infectious patients, animals;
- consumption of foods that are not sufficiently thermally treated qualitatively;
- suffered injuries, surgeries, eye infections.
The inspection consists of a series of activities:
- definition of visual acuity;
- revealing changes in the fields of vision;
- assessment of pupillary response to light;
- measurement of intraocular pressure( with iridocyclitis, it is possible both for its reduction and for an increase depending on the severity of the disease);
- external examination of the cornea, conjunctiva, eyelids, skin around the eyes;
- gonioscopy - detection of exudate, synechia, sprouting of capillaries in the iris( neovascularization);
- biomicroscopy of the cornea, anterior chamber of the eye, lens, vitreous;
- direct ophthalmoscopy - detection of concomitant retinal pathologies;
- biomicroscopy of the fundus;
- photographing of the fundus;
- eye ultrasound, etc.
Laboratory studies are primarily aimed at identifying the cause of iridocyclitis.This includes various analyzes that can detect infectious or toxic agents, autoimmune or allergic processes.
Among instrumental studies, in addition to those listed, there are:
- vascular biopsy;
- vitreous biopsy;
- paracentesis of the anterior chamber of the eye;
- Mantoux reaction;
- is a lumbar puncture.
Treatment of iridocyclitis
Iridocyclitis is an acute inflammatory disease, the treatment of which should begin as early as possible. The aim of it is:
- Suppression of inflammatory reaction;
- prophylaxis of relapses and reduction of their frequency;
- preservation and / or improvement of visual functions;
- prevention of complications( glaucoma, cataracts, vitreous fibrosis, macular degeneration, retinal detachment).
Hospitalization is indicated in cases of acute inflammation.Also, only in hospital conditions, surgical operations are carried out for complications of iridocyclitis.
Iridocyclitis often combines with other diseases or is their complication.Therefore, it is necessary to treat not only him, but also the main pathology. Nevertheless, there are general principles for the therapy of iridocyclitis, which are adjusted depending on the cause:
- drip introduction into the conjunctival bag of special solutions of antibiotics, glucocorticoid hormones, anti-inflammatory drugs;
- introduction to the conjunctiva of glucocorticoids and means for dilating the pupil;
- Introduction to parabulbar fiber of corticosteroids, antibiotics, antioxidants;
- receiving the same, as well as antiviral and cytotoxic drugs inside, as well as their intravenous administration;
- antibiotics can be administered and intramuscularly.
Operation with anterior uveitis
In addition to medical therapy, surgical methods of treatment are also used.True, the operation is not fought with iridocyclitis itself, but with its complications, with those pathological conditions that can deprive the patient of vision.
Ophthalmologists use the following types of surgical and microsurgical operations:
- photodynamic therapy;
- antiglaucomatous interventions;
- vitrectomy( removal of the vitreous with replacement of its artificial environment);
- lenvitretectomy( previous operation in combination with lens removal).
Iridocyclitis can easily become chronic.Especially often it happens in diseases that can not be completely cured( for example, with Bechterew's disease or rheumatoid arthritis).Therefore, to prevent recurrences and exacerbations, operations are performed only in parallel with powerful anti-inflammatory treatment with glucocorticoids and / or cytostatics, connecting, if necessary, specific
Depending on the severity of the course, timeliness of the therapy and its adequacy, iridocyclitis may lead to a decreaseAbility to work for a period of 2 weeks to six months.Persistent loss of vision is a relatively frequent outcome of this unpleasant disease.Therefore, it should be treated by an experienced ophthalmologist.From the patient only it is required to address to the doctor as soon as possible.
Bozbey Gennady Andreevich, ambulance doctor