LECTURE No. 15. Iridocyclitis

Iridocyclitis is an inflammation of the anterior choroid (iris and ciliary body).

Etiology and pathogenesis. The causes of the disease are general diseases of the body, often of an infectious nature, viral infections, rheumatism, tuberculosis, focal infections, eye injuries, syphilis, toxoplasmosis, diabetes, gout, gonorrhea, brucellosis. The disease occurs as a result of the introduction with blood into the tissue of the iris and ciliary body of pathogens of various infections and their toxins or various toxic-allergic reactions to various inflammatory processes, as well as a complication of inflammatory diseases of the cornea or penetrating damage to the eyeball.

clinical picture. There are two forms of iridocyclitis acute and chronic.

Acute iridocyclitis

Acute iridocyclitis is the cause of severe pain in the eye, photophobia, lacrimation, blepharospasm, and headache. Diffuse hyperemia of the sclera around the cornea with a purple tint (pericorneal injection), discoloration and blurring of the iris pattern, narrowing and deformation of the pupil, and its poor reaction to light are characteristic.

When the pupil is dilated (with a 1% solution of platiphylline, a 1% solution of homatropine, a 0,25% solution of scopolamine or a 1% solution of atropine), as a result of adhesions of the iris to the anterior surface of the lens, the pupil takes on an irregular stellate shape. The moisture in the anterior chamber becomes cloudy, and a gelatinous exudate forms in the area of ​​the pupil. So-called grayish-white precipitates, round-shaped deposits of exudate, appear on the posterior surface of the cornea. In severe cases, purulent exudate is visible and clouding is detected in the vitreous body. The disease is long-term, with relapses.

Influenza iridocyclitis occurs and proceeds acutely, the pain syndrome is expressed slightly. The pathological process is manifested in a sharp pericorneal reaction, the appearance of serous exudate, the deposition of precipitates in the form of small dots on the posterior surface of the cornea. Often there are fusions of the pupillary edge of the iris with the anterior capsule of the lens in the form of separate thin pigmented posterior synechiae.

Over time, as a result of increased permeability of the vessels of the ciliary body, a gentle opacification forms in the vitreous body. The outcome of the process is favorable, but relapses are possible. One eye is most commonly affected.

Rheumatic iridocyclitis begins acutely and proceeds rapidly. Hemorrhage is observed in the anterior chamber, as well as under the conjunctiva, there is a sharp mixed injection of the eyeball. Exudation has a gelatinous character, insignificant, but there are numerous pigmented posterior synechia. The vitreous body is rarely involved in the pathological process. Both eyes are affected. The disease occurs in autumn and spring, coincides with relapses of rheumatism.

Iridocyclitis in collagen diseases. The most studied is iridocyclitis in infectious nonspecific polyarthritis. Eye damage occurs suddenly, its course is sluggish. The earliest signs are small precipitates on the posterior surface of the cornea near the inner and outer limbus. Later, ribbon-like and multiple dry precipitates appear on the cornea on the posterior surface of the cornea, as well as delicate ribbon-like opacities in the deep layers of the cornea near the inner and outer limbus. Later, on the cornea, ribbon-like and multiple opacities become coarse, capture the cornea throughout the entire palpebral fissure, vessels from the limbus, as a rule, are not suitable for opacities. The stroma of the iris is atrophic, vessels are visible, new vessels are formed, multiple posterior synechiae, and sometimes adhesions, pupillary infection and vitreous clouding are possible. Then a secondary cataract develops. Both eyes are most commonly affected.

Chronic iridocyclitis

The course of chronic iridocyclitis is sluggish, sometimes with slight pain, moderate hyperemia, but exudation often occurs, which leads to the formation of coarse adhesions of the iris with the lens, the deposition of exudate in the vitreous body, and atrophy of the eyeball. An important role in the development of chronic iridocyclitis is played by the herpes simplex virus, tuberculosis, penetrating wounds of the eye.

Tuberculous iridocyclitis has a sluggish course, occurs gradually, is characterized by the appearance of new vessels in the iris, which sometimes fit and surround single or multiple tuberculomas. There may be flying nodules along the edge of the pupil. The precipitates are large, have a greasy appearance, contain a lot of exudate. Synechiae are wide, relatively often they lead to complete fusion and infection of the pupil, there are opacities in the vitreous body. The cornea and sclera may be affected. One eye is most commonly affected.

Complications. Secondary cataract, fusion of the pupil, fusion of the pupillary edge of the iris throughout with the anterior capsule of the lens, which is accompanied by a violation of the outflow of intraocular fluid, resulting in secondary glaucoma. Treatment of complications is carried out in accordance with the clinical picture and treatment of the underlying disease.

Treatment and prevention. Treatment of iridocyclitis is reduced to the treatment of the underlying disease and special ophthalmic treatment. The latter includes dilation of the pupil with mydriatics. With the formation of posterior adhesions, the introduction of fibrinolysin and a mixture of mydriatics by electrophoresis is recommended.

Anti-inflammatory and antiallergic drugs are prescribed: corticosteroids in the form of instillations of a 5% cortisol solution 56 times a day or subconjunctival injections. When the process subsides, resorption therapy is indicated: instillation of ethylmorphine, electrophoresis with aloe extracts, lidase, thermal procedures.

Prevention is based on the timely treatment of the underlying disease and the elimination of chronic foci of infection.

Author: Shilnikov L.V.

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