Treatment of iridocyclitis of infectious and traumatic etiology

Anterior uveitis or iridocyclitis is inflammatory combined lesion that affects the ciliary body and iris (iris) of the eye. During acute iridocyclitis, there is a decrease in visual acuity, pain and redness in the eye, swelling, change in the color of the iris, lacrimation, the formation of precipitates and hypopyon, deformation and narrowing of the pupil.

Diagnosis of iridocyclitis includes palpation, examination, visual acuity testing, ultrasound and eye biometry, immunological and clinical laboratory studies, and measurement of intraocular pressure.

Conservative therapy for iridocyclitis is based on antiviral, antibacterial and anti-inflammatory treatment, the prescription of detoxification, hormonal, antihistamines, vitamins, immunomodulators, and mydriatics.

Iridocyclitis: general description of the disease

Iridocyclitis, keratouveitis, cyclitis, iritis in ophthalmology refer to the so-called anterior uveitis - inflammatory processes of the ocular choroid. Due to the close functional and anatomical interaction of the ciliary body and the iris, the process of inflammation, which began in one of these parts of the ocular choroid, quickly passes to the other and occurs in the form of iridocyclitis.

Iridocyclitis can be detected in people of any age, but most often in people 25-45 years old.

According to the course of the disease they are distinguished:

• chronic;
• acute iridocyclitis.

After the passage of inflammatory changes:

• exudative;
• serous;
• hemorrhagic;
• fibrinous-plastic.

By origin:

• infectious-allergic;
• infectious;
• post-traumatic;
• allergic non-infectious;
• caused by syndromic and systemic diseases;
• unknown etiology.

The duration of chronic iridocyclitis is several months, acute - 4-5 weeks. Moreover, relapses and disease most often appear in the cold season.

Iridocyclitis: causes of occurrence

Iridocyclitis is also caused by past protozoal, bacterial or viral diseases (measles, influenza, streptococcal and staphylococcal infections, HSV, gonorrhea, tuberculosis, malaria, toxoplasmosis, chlamydia, etc.), as well as foci of chronic infection in the nasopharynx and oral cavity ( tonsillitis, sinusitis).

The cause of iridocyclitis may be systemic diseases of unknown etiology (Vogt-Koyanagi-Harada disease, Behcet's syndrome, sarcoidosis), metabolic disorders (diabetes, gout), rheumatoid conditions (Still's disease, rheumatism, Sjögren's and Reiter's syndromes, ankylosing spondylitis, autoimmune thyroiditis) . The prevalence of iridocyclitis in people with infectious and rheumatic diseases is approximately 45% of total cases.

The appearance of iridocyclitis is facilitated by the developed ocular vascular network and the high susceptibility of the ciliary body and iris to CEC and antigens that come from non-infectious sources of sensitization or extraocular foci of infection.

During the development of iridocyclitis, in addition to damage directly to the choroid by bacteria or their toxins, its immunological disorder with the involvement of inflammatory mediators. The inflammatory process is accompanied by dysfermentosis, vasculopathies, immune cytolysis, microcirculation disorders with further degeneration and scarring.

Also of great importance in the cause of the appearance of iridocyclitis are provoking factors - stressful situations, immune and endocrine disorders, excessive physical activity, hypothermia.

Iridocyclitis: symptoms of the disease

Features of the course and severity of iridocyclitis will depend on the immune status and genotype of the organism, the degree of permeability of the blood-ophthalmic barrier, etiology and duration of action of the antigen.

With iridocyclitis, as a rule, there is unilateral infection of the eyes.

The first symptoms of an acute disease are pain in the eye and general redness, with a characteristic significant increase in pain symptoms when pressing on the eyeball.

The progression of the disease is characterized by a significant decrease in image clarity and a change in the color of the inflamed membrane of the iris (rusty-red or greenish). Probably a manifestation of pericorneal injection of the vessels of the eyeball, a pronounced moderate corneal syndrome.

exudate may be noted in the ocular anterior chamber . As purulent exudate settles at the bottom of the anterior chamber of the eye, a hypopyon appears in the form of a yellow-green or gray stripe.

During a rupture of the vessel, an accumulation of blood in the anterior chamber is detected - hyphema.

The process of inflammation in the ciliary region, when exudate settles on the fibers of the vitreous body and the surface of the lens, can lead to a decrease in visual acuity and clouding.

With iridocyclitis, grayish-white precipitates appear on the posterior surface of the cornea from exudate and pinpoint cell deposits; when they are absorbed, pigment lumps are observed for a long time. In the presence of exudate, swelling of the iris tissue and its tight contact with the anterior lens capsule leads to the formation of synechiae (posterior adhesions), which cause miosis (irreversible narrowing), worsening of the pupil's response to light and its deformation. When the anterior part of the lens and iris fuses, a circular commissure . Synechia creates a risk of blindness if the progression of iridocyclitis is unfavorable due to complete occlusion of the pupil.

With iridocyclitis, intraocular pressure is often lower than normal due to suppression of moisture secretion in the anterior chamber. In some cases, when the lens fusions with the pupillary edge of the iris or acutely developing iridocyclitis with severe exudation, an increase in intraocular pressure is noted.

Different types of iridocyclitis differ in their clinical manifestations of symptoms:

• Tuberculous iridocyclitis occurs with mild symptoms, characterized by the presence of yellowish tubercles (tubercles) on the iris, large “greasy precipitates”, the formation of powerful posterior stromal synechiae, opalescence of the anterior chamber moisture, complete fusion of the pupil or blurred vision.
• Viral iridocyclitis is characterized by increased intraocular pressure, the formation of light precipitates and serous-fibrinous or serous exudate, as well as a torpid course.
• In Reiter's disease, iridocyclitis, which is caused by chlamydial infection, is accompanied by joint damage, urethritis and conjunctivitis with minor signs of inflammation of the choroid.
• With traumatic iridocyclitis, sympathetic ophthalmia (sympathetic inflammation of the healthy eye) may appear.
• Autoimmune iridocyclitis against the background of exacerbations of the underlying disease is characterized by a severe relapsing course with frequent complications (secondary glaucoma, cataracts, eyeball atrophy, scleritis, keratitis). Any relapse is more severe than the previous one and often leads to complete loss of vision.

Diagnosis of the disease

The diagnosis of iridocyclitis is determined according to a comprehensive study: x-ray, laboratory diagnostic, ophthalmological, and examination of the patient by more specialized specialists.

The ophthalmologist initially collects anamnestic data, palpation, and external examination of the eyeball.

To clarify the diagnosis, intraocular pressure is measured using non-contact or contact tonometry, visual acuity is checked, ultrasound of the eye with a two-dimensional or one-dimensional image of the eyeball, and biomicroscopy of the eye, which reveals damage to the ocular structures. With iridocyclitis, the ophthalmoscopy procedure is often complicated due to altered and inflamed anterior ocular areas.

To determine the etiology of the disease, biochemical and general urine and blood tests are prescribed, rheumatic tests to determine systemic diseases, coagulogram, ELISA and PCR diagnostics of the causative agent of inflammation (including tuberculosis, syphilis, chlamydia, herpes, etc.), allergy tests (general and local reactions to the introduction of staphylococcus, streptococcus allergens, specific antigens: toxoplasmin, tuberculin, etc.).

Taking into account the specific clinical symptoms of the disease, examination and consultation with a phthisiatrician, rheumatologist, otolaryngologist, dentist, dermatovenerologist, and allergist are required. X-rays of the paranasal sinuses and lungs are likely to be performed.

They make a differential diagnosis of iridocyclitis and other diseases that are accompanied by redness and swelling of the eyes, such as an acute attack of primary glaucoma, keratitis, acute conjunctivitis.

Iridocyclitis: treatment of the disease

Treatment of this disease must be timely and, if possible, aimed at removing the cause of its occurrence.

Conservative treatment is focused on reducing the risk of complications, preventing the appearance of posterior synechiae and includes planned therapy and emergency measures. In the first hours of the disease, antihistamines and instillation of corticosteroids and NSAIDs that enlarge the pupil (mydriatics) into the eye are prescribed.

Planned treatment is carried out in a hospital setting, it is based on general and local antiviral, antibacterial or antiseptic therapy, the administration of hormonal and non-steroidal anti-inflammatory drugs (in the form of subconjunctival, parabulbar intravenous or intramuscular injections, as well as eye drops). Corticosteroids are most often used in the treatment of autoimmune and toxic-allergic genesis of iridocyclitis.

For iridocyclitis, instillations of mydriatic solutions are performed, which prevent the fusion of the lens with the iris, and detoxification treatment (for severe inflammation - hemosorption, plasmapheresis).

During treatment, multivitamins, local proteolytic enzymes for the resorption of adhesions, precipitates and exudate, antihistamines, immunosuppressants or immunostimulants (taking into account the underlying disease) are prescribed.

Physiotherapeutic measures are often used: laser therapy, magnetic therapy, electrophoresis.

Iridocyclitis of syphilitic, tuberculous, rheumatic, toxoplasmic etiology requires specific treatment under the supervision of appropriate doctors.

Surgical intervention is performed in case of secondary glaucoma, if it is necessary to separate adhesions (separation of posterior and anterior synechiae of the iris). In case of severe complication of purulent iridocyclitis with lysis of the contents of the eye and membranes, surgical removal of the former is recommended (evisceration of the eye, enucleation).

Disease prevention and prognosis

Iridocyclitis sometimes progresses to a chronic stage with persistent deterioration of vision. In untreated or advanced stages, severe complications appear that threaten vision and the existence of the eyeball: fusion or fusion of the pupil, chorioretinitis, cataracts, secondary glaucoma, vitreous abscess, retinal detachment or deformation of the vitreous, atrophy or subatrophy of the eyeball, panophthalmitis and endophthalmitis.

Prevention of the disease consists of sanitation of foci of chronic infection in the body and timely treatment of the underlying disease. Preventative regular examinations by key specialists can help you maintain a high quality of life and your health.

Source: https://glaz.guru/zabolevaniya/chto-eto-takoe-glaznoe-zabolevanie-iridociklit.html

Iridocyclitis

Iridocyclitis (anterior uveitis) is a combined inflammatory lesion affecting the iris (iris) and ciliary body of the eye. In acute iridocyclitis, swelling, redness and pain in the eye, lacrimation, change in iris color, narrowing and deformation of the pupil, formation of hypopyon, precipitates, and decreased visual acuity are observed. Diagnosis of iridocyclitis includes examination, palpation, biometry and ultrasound of the eye, testing visual acuity, measuring intraocular pressure, conducting clinical laboratory and immunological studies. Conservative treatment of iridocyclitis is based on anti-inflammatory, antibacterial and antiviral therapy, the prescription of antihistamines, hormonal, detoxification drugs, mydriatics, immunomodulators, and vitamins.

Iridocyclitis, iritis, cyclitis, keratouveitis are classified in ophthalmology as so-called anterior uveitis - inflammation of the choroid.

Due to the close anatomical and functional interaction of the iris and the ciliary (ciliary) body, the inflammatory process, starting in one of these parts of the choroid, very quickly spreads to the other and occurs in the form of iridocyclitis.

Iridocyclitis is diagnosed in people of any age, but more often in patients from 20 to 40 years old.

According to the course of the disease, acute and chronic iridocyclitis are distinguished; by the nature of the inflammatory changes - serous, exudative, fibrinous-plastic and hemorrhagic; by etiology - infectious, infectious-allergic, allergic non-infectious, post-traumatic, of unknown etiology, as well as caused by systemic and syndromic diseases. The duration of acute iridocyclitis is 3-6 weeks, chronic - several months; the disease and relapses usually occur during the cold season.

Causes of iridocyclitis

The causes of iridocyclitis are diverse and can be endogenous or exogenous. Often, iridocyclitis develops as a result of traumatic injury to the eye (wound, contusion, ophthalmic surgery), inflammation of the iris (keratitis).

Iridocyclitis can be caused by viral, bacterial or protozoal diseases (influenza, measles, HSV, staphylococcal and streptococcal infections, tuberculosis, gonorrhea, chlamydia, toxoplasmosis, malaria, etc.

), as well as existing foci of chronic infection in the nasopharynx and oral cavity (sinusitis, tonsillitis).

The cause of iridocyclitis can be rheumatoid conditions (rheumatism, Still's disease, autoimmune thyroiditis, ankylosing spondylitis, Reiter's and Sjögren's syndromes), metabolic disorders (gout, diabetes), systemic diseases of unknown etiology (sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada syndrome). The prevalence of iridocyclitis among patients with rheumatic and infectious diseases is about 40% of cases.

The occurrence of iridocyclitis is facilitated by the developed vascular network of the eye and the increased susceptibility of the iris and ciliary body to antigens and CECs coming from extraocular foci of infection or non-infectious sources of sensitization.

Hemorrhoids kill the patient in 79% of cases

With the development of iridocyclitis, in addition to direct damage to the choroid by microbes or their toxins, immunological damage occurs with the participation of inflammatory mediators. Inflammation is accompanied by phenomena of immune cytolysis, vasculopathies, dysfermentosis, microcirculation disorders with subsequent scarring and dystrophy.

Of no small importance in the development of iridocyclitis are provoking factors - endocrine and immune disorders, stressful situations, hypothermia, excessive physical activity.

Symptoms of iridocyclitis

The severity and characteristics of the course of iridocyclitis depend on the nature and duration of exposure to the antigen, the level of permeability of the blood-ophthalmic barrier, the genotype and immune status of the body. With iridocyclitis, unilateral eye damage is usually observed.

The first signs of acute iridocyclitis are general redness and pain in the eye, with a characteristic significant increase in pain when pressing on the eyeball.

Patients with iridocyclitis experience photophobia, lacrimation, a slight (within 2-3 lines) decrease in visual acuity, and the appearance of “fog” before the eyes.

Serous, fibrinous or purulent exudate may be detected in the anterior chamber of the eye.

When purulent exudate settles at the bottom of the anterior chamber of the eye, a hypopyon is formed in the form of a gray or yellow-green stripe; When a vessel ruptures in the anterior chamber, an accumulation of blood is detected - hyphema.

The inflammatory process in the ciliary body, when exudate settles on the surface of the lens and the fibers of the vitreous body, can lead to clouding and a decrease in visual acuity.

On the posterior surface of the cornea, with iridocyclitis, grayish-white precipitates appear from pinpoint deposits of cells and exudate, during the resorption of which pigment lumps are observed for a long time.

Swelling of the iris tissue and its close contact with the anterior capsule of the lens in the presence of exudate leads to the formation of posterior adhesions (synechias), causing irreversible narrowing (miosis) and deformation of the pupil, worsening its reaction to light.

When the iris and the anterior surface of the lens fusion, a circular adhesion is formed along its entire length. If the course of iridocyclitis is unfavorable, synechia creates a risk of developing blindness due to complete occlusion of the pupil.

Often, intraocular pressure during iridocyclitis is below normal due to inhibition of the secretion of moisture in the anterior chamber. Sometimes, with acute onset iridocyclitis with severe exudation or fusion of the pupillary edge of the iris with the lens, an increase in intraocular pressure is observed.

Tuberculous iridocyclitis occurs with mild symptoms, manifested by the presence of large “greasy precipitates”, yellowish tubercles (tubercles) on the iris, opalescence of the anterior chamber moisture, the formation of powerful posterior stromal synechiae, blurred vision or complete occlusion of the pupil.

Autoimmune iridocyclitis is characterized by a severe recurrent course against the background of exacerbations of the underlying disease with frequent development of complications (cataracts, secondary glaucoma, keratitis, scleritis, atrophy of the eyeball). Each relapse is more severe than the previous one and often leads to blindness.

With traumatic iridocyclitis, sympathetic inflammation of the healthy eye (sympathetic ophthalmia) may develop. Iridocyclitis in Reiter's syndrome, caused by chlamydial infection, is accompanied by conjunctivitis, urethritis and joint damage with minor manifestations of inflammation of the choroid.

Diagnosis of iridocyclitis

The diagnosis of iridocyclitis is established based on the results of a comprehensive examination: ophthalmological, laboratory diagnostic, x-ray, and consultation of the patient with specialists.

Initially, an ophthalmologist performs an external examination of the eyeball, palpation, and collection of anamnestic data.

To clarify the diagnosis of iridocyclitis, visual acuity is checked, intraocular pressure is measured using contact or non-contact tonometry, eye biomicroscopy, which reveals damage to the ocular structures, and ultrasound of the eye with a one-dimensional or two-dimensional image of the eyeball. The ophthalmoscopy procedure for iridocyclitis is often difficult due to inflammatory changes in the anterior parts of the eye.

To determine the etiology of iridocyclitis, general and biochemical blood and urine tests, a coagulogram, rheumatic tests to identify systemic diseases, allergy tests (local and general reactions to the introduction of allergens streptococcus, staphylococcus, specific antigens: tuberculin, toxoplasmin, etc.), PCR and ELISA diagnostics are prescribed causative agent of inflammation (including syphilis, tuberculosis, herpes, chlamydia, etc.).

To assess the immune status, a study of the level of serum immunoglobulins in the blood IgM, IgG, IgA, as well as their content in the tear fluid, is performed.

Depending on the characteristics of the clinical picture of iridocyclitis, consultation and examination with a rheumatologist, phthisiatrician, dentist, otolaryngologist, allergist, dermatovenerologist is necessary. X-rays of the lungs and paranasal sinuses are possible.

Differential diagnosis of iridocyclitis and other diseases accompanied by swelling and redness of the eyes, such as acute conjunctivitis, keratitis, and acute attack of primary glaucoma, is carried out.

Treatment of iridocyclitis

Treatment of iridocyclitis should be timely and, if possible, aimed at eliminating the cause of its occurrence.

Conservative treatment of iridocyclitis is focused on preventing the formation of posterior synechiae, reducing the risk of complications and includes emergency measures and planned therapy. In the first hours of the disease, instillation of pupil dilators (mydriatics), NSAIDs, corticosteroids, and antihistamines into the eye is indicated.

Planned treatment of iridocyclitis is carried out in a hospital setting, it is based on local and general antiseptic, antibacterial or antiviral therapy, the administration of anti-inflammatory non-steroidal and hormonal drugs (in the form of eye drops, parabulbar, subconjunctival, intramuscular or intravenous injections. Corticosteroids are widely used in the treatment of toxic iridocyclitis allergic and autoimmune origin.

Prescribe antihistamines, multivitamins, immunostimulants or immunosuppressants (depending on the underlying disease), local proteolytic enzymes for the resorption of exudate, precipitates and adhesions.

Physiotherapeutic procedures are often used for iridocyclitis: electrophoresis, magnetic therapy, laser therapy.

Iridocyclitis of tuberculous, syphilitic, toxoplasmosis, rheumatic etiology requires specific therapy under the supervision of appropriate specialists.

Surgical treatment of iridocyclitis is carried out if it is necessary to separate adhesions or (dissection of the anterior and posterior synechiae of the iris), in the case of the development of secondary glaucoma. In case of severe complications of purulent iridocyclitis with lysis of the membranes and contents of the eye, surgical removal of the latter (enucleation, evisceration of the eye) is indicated.

Forecast and prevention of iridocyclitis

The prognosis of iridocyclitis with timely, adequate and careful treatment is quite favorable.

Complete recovery after treatment of acute iridocyclitis is observed in approximately 15-20% of cases; in 45-50% of cases, the disease takes a subacute relapsing course with more subtle relapses, which often coincide with exacerbations of the underlying disease (rheumatism, gout).

Iridocyclitis can become chronic with persistent vision loss.

Prevention of iridocyclitis consists of timely treatment of the underlying disease, sanitation of foci of chronic infection in the body.

Source: https://illnessnews.ru/iridociklit/

Iridocyclitis: types, causes, symptoms, diagnosis, treatment

The second name for iridocyclitis is anterior uveitis. This term consists of two parts. Uveitis is a broad term that refers to an inflammatory process in the uvea of ​​the eye.

The anterior part of the vascular tract of the eye includes the iris and ciliary body, damage to which is observed in iridocyclitis.

By the way, posterior uveitis is called inflammation of the posterior part of the choroid, which lines the inside of the eyeball.

Causes

Iridocyclitis of the eye almost always develops against the background of another disease. Sometimes it is the first sign of serious autoimmune, metabolic, and endocrine disorders.

There are many cases where a person came to the ophthalmologist with uveitis, and was later diagnosed with severe systemic diseases.

Thus, the development of uveitis is an alarm bell signaling health problems.

Depending on the origin, anterior uveitis can be exogenous or endogenous. The first develops as a result of infection from the external environment. Endogenous iridocyclitis occurs in people with chronic infections, autoimmune diseases, metabolic disorders and pathologies of the endocrine system.

Internal factors

The impetus for the development of endogenous uveitis is the penetration of harmful microbes into the iris and ciliary body. Pathogenic microorganisms enter there through the bloodstream and cause the development of an inflammatory process. In addition, inflammation can occur under the influence of autoantibodies or immune complexes that circulate in the blood of people with autoimmune diseases.

Causes of endogenous iridocyclitis:

• previous bacterial, viral, protozoal infections - syphilis, chlamydia, toxoplasmosis, gonorrhea, influenza, measles;
• the presence of foci of chronic infection in the body - chronic tonsillitis, sinusitis, otitis, sinusitis;
• rheumatic diseases - rheumatoid arthritis, ankylosing spondylitis, rheumatism, Sjögren's and Reiter's syndromes;
• metabolic disorders and some systemic diseases of unknown etiology - diabetes mellitus, gout, autoimmune thyroiditis, sarcoidosis, Behçet's disease.

A number of provoking factors contribute to the development of anterior uveitis. People with weakened immune systems and disruption of the endocrine system are especially susceptible to pathology. Frequent stressful situations, hypothermia, and heavy physical activity also have a negative impact.

External factors

Inflammation of the iris and ciliary body can be a consequence of microbial contamination during trauma, surgery, or infectious lesions of the anterior segment of the eye. In this case, pathogenic microorganisms enter the choroid by contact and cause an inflammatory process.

The most common causes of exogenous iridocyclitis:

Note that postoperative iridocyclitis can be reactive. This kind of uveitis does not develop due to infection. The reason for its development is an overly active reaction of the eye to surgical intervention.

Classification

Depending on the severity of the inflammatory process, acute and chronic iridocyclitis are distinguished. Both types of disease most often affect one eye, much less often the process is bilateral. Anterior uveitis can occur at any age, but is most often diagnosed in people 32–45 years old.

Acute iridocyclitis occurs spontaneously, after injuries, operations or infections. It has a pronounced clinical picture and is easily diagnosed.

If you consult a doctor in a timely manner, the disease responds well to treatment and goes away without any consequences after 3–4 weeks.

Chronic iridocyclitis is characterized by a long, asymptomatic course. Typical symptoms of the disease appear in a person only during an exacerbation. After a course of treatment, the patient goes into remission, but soon the pathology makes itself felt again. Exacerbations can occur 2-3 times a year.

Types of iridocyclitis according to the nature of inflammation

View
Description
Course and prognosis

Serous	It is characterized by the accumulation of serous fluid in the chambers of the eye. Small precipitates usually form on the cornea. Pathology often leads to increased intraocular pressure	The most favorable form of iridocyclitis, which has a relatively mild course. Rarely seen
Exudative	Accompanied by the appearance of large precipitates on the cornea and the formation of adhesions between the iris and the anterior capsule of the lens. In this case, pus accumulates in the anterior chamber of the eye. It may settle to form a hypopyon. The latter looks like a yellow stripe or crescent located along the lower edge of the iris	It is difficult and often leads to occlusion of the pupil and swelling of the iris. If left untreated, it leads to a sharp increase in intraocular pressure and the development of severe complications. Adequate therapy helps to cope with the disease in 3–4 weeks
Fibrinous-plastic iridocyclitis	Leads to the appearance of fibrous exudate in the anterior chamber of the eyeball with its subsequent organization. Whitish-gray fibrin threads are clearly visible when examined at the slit lamp	It has the most severe and unfavorable course. Among all uveitis, it is the most common cause of irreversible pupillary fusion and complete blindness.
Hemorrhagic	It manifests itself as an accumulation of blood, that is, the formation of a hyphema. The cause of this phenomenon is most often damage to the vessels supplying the iris and ciliary body. Hemorrhagic iridocyclitis is often viral in nature	Requires long-term treatment and the use of absorbable drugs. Can be completely cured with adequate therapy

According to the mechanism of development, iridocyclitis can be infectious, allergic, post-traumatic, postoperative, infectious-allergic. In some cases, doctors are unable to determine the nature of the disease. In this case we are talking about idiopathic anterior uveitis.

Symptoms

The severity of the clinical picture of the disease depends on many factors: the cause of the development of the pathology, the virulence of the pathogen, the state of human immunity and the activity of the inflammatory process. In some cases, anterior uveitis is practically asymptomatic, while in others it brings a lot of suffering to a person.

Classic symptoms of iridocyclitis:

• pain and discomfort;
• redness of the eye;
• lacrimation;
• intolerance to bright light;
• the appearance of fog before the eyes;
• decreased visual acuity;
• the appearance of yellow or red effusion in the anterior chamber;
• change in iris color;
• headache.

Decreased visual acuity in iridocyclitis is caused by swelling of the cornea and sedimentation of precipitates on its inner surface. In addition, cellular elements may appear in the intraocular fluid, causing it to become opalescent (Tyndall's symptom).

All this leads to a violation of the transparency of the optical media of the eye and the appearance of fog before the eyes. Adequate treatment helps eliminate unpleasant symptoms and restore good vision to a person.

Which doctor treats iridocyclitis?

Diagnosis and treatment of iridocyclitis is carried out by an ophthalmologist together with other specialists.

If necessary, he refers the patient for consultation with an infectious disease specialist, dermatovenerologist, rheumatologist, phthisiatrician, endocrinologist, neurologist or ENT doctor. If they detect a concomitant disease in the patient, they prescribe the necessary treatment.

Diagnostics

The doctor may suspect the disease after a conversation and examination of the patient. Iridocyclitis is also supported by a decrease in visual acuity, which is not amenable to optical correction with plus and minus lenses. To confirm the diagnosis, an ophthalmologist will need to perform a slit lamp examination of the eyes.

Ophthalmoscopic signs of anterior uveitis:

• Swelling of the cornea and the appearance of precipitates on its inner surface. Precipitates can have different sizes and colors. As a rule, they are located in the lower part of the cornea and have the shape of a triangle, located with the base downwards. In severe cases of the disease, precipitates cover the entire cornea.
• Pericorneal vascular injection. It looks like a reddish-blue rim around the limbus. Occurs in response to an inflammatory process in the iris and ciliary body.
• Change in iris color. Not always observed. In some cases, the iris may take on a characteristic rusty tint.
• Posterior synechiae. They look like cords connecting the iris to the anterior capsule of the lens. In severe cases, they cause complete occlusion of the pupil, which can be noticed upon examination.
• Stability of the pupil and lack of reaction to light. Usually a consequence of the formation of synechiae. In the absence of timely treatment, it can lead to bombardment of the iris.
• Accumulation of pus or blood in the anterior chamber of the eye. Doesn't always appear. Speaks of a severe course of the disease.

Intraocular pressure (IOP) with iridocyclitis can be normal or elevated. An increase in IOP may be due to the accumulation of serous fluid, exudate or blood in the anterior chamber. In some cases, intraocular pressure increases due to occlusion of the pupil and bombardment of the iris. This phenomenon is extremely dangerous and requires immediate medical attention. Read more about glaucoma →

Treatment

Treatment of iridocyclitis is carried out using different groups of drugs. The treatment regimen is drawn up on an individual basis, taking into account the cause of the disease and its causative agent. For example, antibiotics are used to combat bacterial uveitis, and antiviral agents are used for viral inflammation.

Medicines used to combat iridocyclitis

Drug groups
Representatives
Purpose and features of use

Mydriatics	Atropine, Tropicamide, Cyclomed, Midriacil	They are used to prevent the formation of posterior synechiae and combat them. If necessary, mydriatics can be used in turn with miotics to perform so-called iris gymnastics. Used as drops or subconjunctival injections
Antibiotics	Oftaquix, Levofloxacin, Moxifloxacin, Ofloxacin, Zinatsef	Prescribed for iridocyclitis of bacterial etiology to combat infection. Also indicated for the development of hypopyon in patients with uveitis of any nature. Antibacterial agents can be used topically (drops, ointments, injections) or systemically (tablets, injections)
Antiviral agents	Virgan, Zovirax, Virolex, Okoferon	They have an antiviral and immunomodulatory effect, thereby destroying the infection that caused the inflammation. Doctors prescribe these drugs in drops or tablets, less often in the form of injections
NSAIDs	They have anti-inflammatory and analgesic effects. Used in the form of eye drops
Steroid hormones	Dexamethasone, Hydrocortisone	They have a powerful anti-inflammatory effect. They are administered parabulbarly or subconjunctivally. Can also be given as eye drops or ointment
Proteolytic enzymes	Necessary in the treatment of acute iridocyclitis complicated by the formation of adhesions, hypopyon or hyphema. Drugs in this group are excellent at breaking up posterior synechiae. Proteolytic enzymes are administered subconjunctivally

Patients with iridocyclitis are required to be hospitalized in an ophthalmological hospital. There they are thoroughly examined and treated. Typically, patients stay in the hospital for 7–12 days. After discharge, they are registered at the dispensary. This means that patients will need to visit an ophthalmologist at their place of residence.

Prevention

The risk of developing iridocyclitis can be reduced by strengthening the immune system and timely treatment of systemic diseases. Sanitation of foci of chronic infection in the body is also important (removal of inflamed tonsils, filling of carious teeth, treatment of chronic sinusitis, otitis, sinusitis).

At the first signs of eye inflammation, you should immediately contact an ophthalmologist. Early diagnosis and treatment of acute inflammation significantly reduces the risk of chronic disease.

As practice shows, in approximately 20% of cases, acute anterior uveitis can be completely cured. However, it often acquires a chronic, relapsing course and bothers a person throughout his life.

Iridocyclitis is an acute or chronic inflammation of the iris and ciliary body of the eye. The disease can develop under the influence of external or internal provoking factors.

Anterior uveitis most often affects people with chronic infections, rheumatic diseases and metabolic disorders.

Injuries, surgeries, and acute viral infections can provoke the development of pathology.

To diagnose the disease, an experienced ophthalmologist only needs to examine the eye using a slit lamp. In order to clarify the cause of iridocyclitis, the patient may be prescribed additional examinations and consultations with other specialists. Pathology is treated with mydriatics, antibiotics, antivirals, steroid hormones and proteolytic enzymes.

Alina Lopushnyak, ophthalmologist,
specially for Okulist.pro

Source: https://okulist.pro/bolezni-glaz/iridociklit.html

Iridocyclitis: symptoms, diagnosis and treatment. Clinics. Consultation with an ophthalmologist

The choroid of the eye consists of the iris, the ciliary (ciliary) body and the choroid itself. Uveitis is an inflammation of the choroid of the eye. Uveitis can be anterior or posterior. Anterior uveitis, or iridocyclitis, is an inflammation of the iris and ciliary body, posterior uveitis is an inflammation of the choroid itself.

In rare cases, iritis and cyclitis are observed, which are isolated inflammations of the iris and ciliary body, respectively. The close anatomical connection and common blood supply determine the involvement of both the iris and the ciliary body in the pathological process.

Iridocyclitis (anterior uveitis) is a combined inflammation of the iris and ciliary body of the eye. The disease can occur in patients of any age, but most often affects the young age category (up to 40 years).

Reasons for the development of iridocyclitis

The development of iridocyclitis is most often caused by the presence of general diseases of the body:

• chronic infection in the paranasal sinuses, teeth, nasopharynx, jaw (hilar cyst);
• infectious diseases of a bacterial nature (brucellosis, tuberculosis, leptospirosis);
• infectious diseases of viral origin (flu, herpes, measles);
• protozoal infections (toxoplasmosis, malaria);
• infectious diseases of fungal etiology.

This form of iridocyclitis is called endogenous.

Often the development of iridocyclitis is caused by various systemic diseases (rheumatism, juvenile rheumatoid arthritis, gout, ankylosing spondylitis, sarcoidosis).

The development of exogenous iridocyclitis is associated with inflammatory diseases of the cornea and sclera, as well as penetrating damage to the eyeballs and surgical interventions.

Factors that can trigger the occurrence of iridocyclitis include hypothermia, excessive physical exertion, stress, and endocrine disorders.

Classification of iridocyclitis

Depending on the etiology, the following types of iridocyclitis are distinguished:

• infectious and infectious-allergic;
• non-infectious allergic;
• caused by systemic and syndromic diseases;
• post-traumatic (including post-operative);
• iridocyclitis caused by other pathologies of the body;
• iridocyclitis of unknown etiology.

In accordance with the course of the disease, iridocyclitis can be acute, subacute, chronic recurrent.

The nature of the inflammatory process determines the serous, exudative, fibrinous-plastic and hemorrhagic forms of iridocyclitis.

Symptoms and diagnosis of iridocyclitis

Iridocyclitis is usually unilateral.

The main complaints of patients are redness of the eye, severe pain in the affected eye, temple area, lacrimation, photophobia, and slight deterioration in vision.

On palpation, the eye is sore. The objective sign of the disease is redness of the eyeball, caused by dilation of the vessels surrounding the limbus (pericorneal injection).

The cornea itself is transparent, but on its back surface there are precipitates of various sizes and colors; they are a collection of cells that accompany the inflammatory process.

Iridocyclitis is characterized by a smoothing of the iris pattern and a change in its color: it becomes greenish or rusty. There is a constriction of the pupil, and the reaction to a light stimulus decreases.

The process of formation of adhesions (posterior synechiae) occurs between the inflamed iris and the anterior capsule of the lens. There is a change in the shape of the pupil, the formation of a circular adhesion up to its complete fusion.

Due to the suppressed secretion of intraocular fluid caused by inflammation of the ciliary body, a decrease in intraocular pressure is observed with iridocyclitis. An increase in intraocular pressure occurs due to a violation of the outflow of intraocular fluid caused by a pronounced adhesive process between the lens and the pupillary edge of the iris.

The clinical picture and course of iridocyclitis depend on the cause that provoked the development of the disease and the state of immunity (both local and general).

The diagnosis is based on typical complaints, palpation results, and examination by an ophthalmologist using a slit lamp. Iridocyclitis must be differentiated from a number of other acute diseases that are accompanied by similar symptoms.

Determination of the cause of the disease is carried out using various clinical, laboratory and instrumental research methods: general and biochemical blood tests to assess the inflammatory reaction of the body, X-ray examination of the lungs, paranasal sinuses (to exclude foci of chronic infection), consultations with specialists: otolaryngologist, dentist, phthisiatrician, endocrinologist, allergist, etc.

Treatment and prevention of iridocyclitis

Treatment of this disease should be carried out in a hospital setting. The main goals of treatment are to reduce inflammation and prevent the formation of adhesions. The causes of the disease determine the choice of treatment method: antibacterial therapy, antiviral drugs, specific therapy (anti-tuberculosis drugs, immunosuppressants or cytostatics).

The use of non-steroidal anti-inflammatory drugs and corticosteroids is often recommended.

In order to achieve resorption of precipitates and exudate, enzyme preparations are prescribed. For prevention purposes, it is advisable to use mydriatics - drugs that dilate the pupil and prevent the formation of adhesions.

Physiotherapeutic treatment (use of electrophoresis) has found widespread use in the treatment of iridocyclitis. The method of autohemotherapy has an excellent absorbable and anti-inflammatory effect. For iridocyclitis with increased intraocular pressure, local and general antihypertensive therapy is prescribed: the use of eye drops, diuretics.

Iridocyclitis, which arose as a result of one or another general disease, requires joint treatment by an ophthalmologist and other appropriate specialist. Timely treatment of iridocyclitis increases the chances of a full recovery.

Prevention of iridocyclitis

In the chronic, often recurrent course of iridocyclitis, serious complications develop, which include a gradual decrease in vision, secondary glaucoma with optic nerve atrophy, complicated cataracts, corneal dystrophy, etc. Therefore, it is so important to diagnose the disease in time, preventing its progression and the development of severe complications.

Prevention of iridocyclitis includes timely treatment of common diseases, elimination of foci of chronic infections (sanitation of the oral cavity, treatment of chronic tonsillitis, sinusitis, etc.).

It is necessary to regularly conduct preventive examinations by primary medical specialists, which will help maintain health and a high quality of life.

Moscow clinics

Below are the TOP 3 ophthalmological clinics in Moscow, where you can undergo diagnosis and treatment of iridocyclitis.

Source: https://mosglaz.ru/blog/item/1177-iridotsiklit.html

Iridocyclitis of the eye and emergency care for its acute attack

Reasons for development. As a complication of acute and chronic infectious processes (influenza, sore throat, inflammation of the paranasal sinuses, rheumatism, tuberculosis, brucellosis, etc.)

Main symptoms. Aching pain in the eye, spreading along the trigeminal nerve, worsening at night and with palpation of the eye (ciliary pain), redness of the eye with a predominance of lilac-pink pericorneal injection. Characteristic changes in color and smoothness of the iris pattern, narrowing of the pupil, often the presence of its adhesions with the lens (posterior synechiae).

The aqueous humor is often cloudy due to exudate, which settles at the bottom of the anterior chamber in the form of a yellowish level (hypopyon), and is deposited on the posterior surface of the cornea in a scattering of pinpoint precipitates. Intraocular pressure is normal or often reduced. Vision is usually reduced.

It is necessary to differentiate with an acute attack of glaucoma; errors in treatment can lead to severe complications that threaten blindness.

Treatment. Aimed primarily at dilating the pupil (to prevent the formation or rupture of posterior synechiae and provide rest to the iris and ciliary body).

Locally - instillation of various mydriatics and their combinations (1% atropine sulfate solution, 0.25% scopolamine solution, 0.5%-1% homatropine, 1%-2% platiphylline, 0.1% adrenaline, 0.5% mydriacyl, 1% tropicamide, 1% cyclomed, 2.5% irifrin, 10% phenylephrine); For injections under the conjunctiva, 0.1% atropine and 1% mesaton are used.

Atropine in powder and ointment. Applications with adrenaline and mesaton. Electrophoresis with mydriatic mixture.

Anti-inflammatory and desensitizing agents: instillation of corticosteroids 4-6 times a day: 0.1% dexamethasone solution, 0.3% prednisolone solution, sofradex; eye drops containing an antibiotic and a steroid drug: Garazon, dexagentamicin, maxitrol, tobradex; non-steroidal anti-inflammatory drugs; naklof, diclof-F, diclofenac. Hydrocortisone ointment 0.5% 3-4 times a day. Injections under the conjunctiva of antibiotics with a 0.4% dexazone solution. Leeches on the temple. Dry heat (UHF therapy, paraffin baths, warm bandage). Orally and intramuscularly - antibiotics, orally - non-steroidal anti-inflammatory drugs (salicylates, butadione, indomethacin) and sulfonamides. In order to absorb exudate in the anterior chamber, fibrinolysin is administered under the conjunctiva at a dose of 400 units.

3. Emergency care for decompensation of intraocular pressure. Acute attack of glaucoma

Reasons for development. Acute disruption of the outflow of intraocular fluid, which can be caused by various changes in the eye.

Main symptoms. Develops suddenly, often after a nervous shock. Severe pain in the eye, radiating to the temple and the corresponding half of the head. Possible pain in the heart and abdomen. Nausea, vomiting. A sharp decrease in vision to the point of counting fingers near the face.

Congestive injection of the eyeball, impaired corneal transparency, corneal edema, shallow anterior chamber, dilated pupil. Intraocular pressure is sharply increased, upon palpation the eyes are dense (T+3), the reflex from the fundus is dull pink, the details of the fundus are not visible.

An uncontrolled attack often leads to blindness. An acute attack of glaucoma can be mistaken for acute iridocyclitis.

In the differential diagnosis of these two diseases, the main signs should be considered a narrow pupil and normal or slightly reduced intraocular pressure during iridocyclitis and, conversely, a wide pupil and sharply increased pressure during an attack of glaucoma.

Pilocarpine 1-2% is instilled locally during the first hour every 15 minutes, then every 30 minutes 3-4 times, then every hour 3 times, then 6 times a day; β-blockers (arutimol, okumed, optimol, timolol, timolol POS, blockarden, timoptic, okupres 0.25-0.5% solutions) 2 times a day; fotil, fotil-forte (contains timolol with 2% and 4% pilocarpine); proxodolol 1-2%; betaxolol 0.5%, betoptik 0.25%); latanoprost, xalatan 0.005% (prostaglandins); Trusopt, Azopt 2% (carbonic anhydrase inhibitors). Osmotic agents: glycerin and urea at the rate of 1.5 g/kg, manitol 20% - IV at the rate of 2.0 g/kg. Carbonic anhydrase inhibitors - diacarb 0.25-0.5 g 1-6 times a day, fonurit 0.25-0.5 g 1 to 6 times a day. Diuretics – Lasix (furosemide) 2.0 g IM. Lytic mixture: aminazine – 1.0; diphenhydramine – 1.0; promedol – 1.0 (contraindicated in patients with low blood pressure). Analgesics (analgin 0.25 g 3 times a day). Distraction therapy: leeches on the temple, hot foot baths. If the attack is not stopped within 24 hours, surgical treatment (iridectomy) is indicated. After drug relief of the attack, laser iridectomy is also indicated.

Emergency care for iridocyclitis

Clinical diagnosis

Differential diagnosis of individual uveitis

A chronic relapsing course of uveitis is more common The disease begins unnoticed, symptoms of eye irritation (lacrimation, blepharospasm, photophobia) are usually absent, and there is a tendency to proliferation and generalization of the process. Both eyes are affected.

In young children, the clinical picture is blurred, which does not allow identifying the etiology of the disease.

In adults with influenza uveitis, the disease begins acutely and is associated with an influenza epidemic; thin posterior pigmented synechiae, small precipitates, and serous, hemorrhagic exudate appear in the anterior chamber. Vitreous opacification is observed.

Rheumatic uveitis is characterized by a high severity of subjective data (complaints) with a weak or moderate severity of objective changes: numerous pigmented posterior synechiae, vitreous opacities, retinovasculitis in the fundus, a tendency to relapse, seasonality.

In uveitis associated with focal infection (diseases of the paranasal sinuses, tonsils, teeth), there are various precipitates and flocculent opacities of the vitreous body.

Tuberculous uveitis is characterized by an inconspicuous onset with scant complaints and pronounced objective changes: the presence of sebaceous precipitates, tuberculous tubercles, “fuzz” along the edge of the pupil, powerful multiple stromal posterior synechiae, involvement of the cornea in the process.

Anterior uveitis (iridocyclitis) is different from an acute attack of glaucoma*. Complications: successive cataracts, secondary glaucoma, neuroretinitis.

Clinical diagnosis is made based on a focused history; laboratory research methods (hemogram, proteinogram, urine test, blood test for immunology, blood test for the Wasserman reaction, Wright reaction, complement fixation reaction with Toxoplasma antigens), skin tests (cutaneous and intradermal tests with tuberculin, graded Pirquet reaction, Mantoux test in various dilutions), reactions with toxoplasmin, herpetic and streptococcal polyantigen, reactions to brucellosis), the above clinical ophthalmological studies

Emergency care for iridocyclitis: pupil dilation and pain relief.

Mydriatics: atropine sulfate 1.0%, scopolamine hydrobromide 0.25%, homotropine hydrobromide solution 1%, platifilin bitartarate solution 1%, adrenaline hydrochloride solution 1.0%, cyclomed 1%, cyclopentolate 1% , tropicamide 1%, irifrin 2.5 - 10% midriacil 1%.

* Kopaeva V.G.. Eye diseases. M., 2002, p. 286.

To determine how successfully the topic has been mastered, it is necessary to diagnose a 3-year-old child whose mother noticed worsening vision in the right eye and a star-shaped pupil. From the anamnesis it was revealed that at the age of 2 the child had swelling of the knee joint.

Objectively: there is mild photophobia, injection and pain in the eyeball are absent. At 3 and 9 o'clock in the superficial layers of the cornea at the limbus, small precipitates of a semilunar shape, fusion and fusion of the pupil are visible, visual acuity is 0.02. There is no fundus reflex.

Correct diagnosis: uveitis of the right eye due to Still's disease.

For practical training:

"Diseases of the vascular tract"

Work stage	Educational element	Practical skill
Anamnesis collection and information synthesis	Complaints Conditions and mode of visual work. Hereditary analysis
Eye examination	Determination of visual acuity. Inspection using side lighting method. Transmitted light inspection	Inspection using side lighting method. Biomicroscopy of the cornea.
Identifying uveitis symptoms	See the manual (9 symptoms of uveitis)
Differential diagnosis	Iritis with iridocyclitis. Iridocyclitis with choroiditis. Iridocyclitis with acute attack of glaucoma. Etiological differential diagnosis
Clinical diagnosis	Anterior uveitis Posterior uveitis Panuveitis
Complication	Cataract. Secondary glaucoma. Neuroretinitis
Laboratory research methods	Immunological techniques. Skin and intradermal tests
Emergency care for iridocyclitis	Pupil dilation Pain relief
Treatment of uveitis	See the manual

• METHODOLOGICAL DEVELOPMENT FOR STUDENTS FOR PRACTICAL LESSON No. 7
• “PRIMARY, CHILDREN’S, JUVENILE GLAUCOMA”
• OBJECTIVE: to study the clinical picture, early diagnosis and principles of treatment of primary, childhood, and juvenile glaucoma.
• IMPORTANT: each student in this practical lesson must become familiar with the clinic, the principles of treatment of primary and congenital glaucoma, pathogenetically oriented operations for primary glaucoma; principles of gonioscopy and tonography. Students must know the theoretical material in accordance with the educational questions posed, master the method of early diagnosis of congenital glaucoma, the Maklakov tonometry method, the method of providing emergency care to a patient with an acute attack of glaucoma; master the following practical skills: determining the size of the cornea, methods of palpation and tonometric examination of intraocular pressure, writing prescriptions for miotic drugs, providing emergency care to a patient with an acute attack of glaucoma

Source: https://domashniy-medic.ru/zrenie/iridotsiklit-glaza-i-neotlozhnaya-pomoshh-pri-ego-ostrom-pristupe