LECTURE No. 16. Clinic and treatment of iritis and hemeralopia

1. Irit

Iritis is an inflammatory process in the iris.

Etiology and pathogenesis. The introduction of infection into the eye during injuries, various diseases (flu, diseases of the teeth and tonsils, tuberculosis, rheumatism, brucellosis, etc.). The introduction of pathogens or their toxins into the choroid occurs through the system of ciliary vessels.

clinical picture. The inflammatory process in the iris begins with aching pains in the eye, which subsequently spread to the temporal region. At the same time, photophobia, lacrimation, blepharospasm appear, vision deteriorates.

On examination, there is dilation of the passing vessels and pericorneal injection. In this case, a pinkish-violet corolla appears around the cornea. The conjunctival cavity remains clean and the cornea is shiny and transparent.

A characteristic sign of iritis is a change in the color of the iris. To get a clear idea of ​​this change, it is recommended to examine the iris in natural light, comparing the color in one and the other eye. Gray and blue irises turn green or rusty, brown turns yellow.

Changing color, the iris becomes cloudy and loses the characteristic pattern of depressions (iris crypts). Hyperemia of the vessels in iritis causes a narrowing of the pupil, which can be easily seen by comparing the diseased eye with a healthy one.

In order to correctly diagnose the disease, it is necessary to know the characteristic differences between iritis and an attack of glaucoma.

With iritis, the pupil of the diseased eye is much smaller and does not react as quickly to light as the pupil of a healthy eye; on palpation, the diseased eye seems softer than the healthy one. With glaucoma, the pupil of the diseased eye is wider than the pupil of the healthy one, and does not narrow when the eye is illuminated; on palpation, the diseased eye seems much harder than the healthy one.

A characteristic feature of iritis are the so-called adhesions (synechia). The adhesions of the iris to the anterior surface of the lens are called posterior iris commissures. They can be detected when mydriatics are instilled into the eye (1% solution of platyphylline, 1% solution of homatropine hydrobromide or 1% solution of atropine). Under their influence, the pupil dilates unevenly, its shape becomes irregular. When mydriatics are instilled into a healthy eye, the pupil, expanding unevenly, retains its regular round shape.

Posterior adhesions pose a certain danger in iritis, since their large accumulation can serve as an obstacle to the penetration of intraocular fluid through the pupil into the anterior chamber, which leads to the formation of excess fluid and, consequently, to an increase in intraocular pressure. If it is not reduced, blindness may occur.

Complications of iritis are decreased visual acuity, cataracts, secondary glaucoma.

Treatment. Emergency care in the treatment of the inflammatory process of the choroid consists primarily of preventing the formation of posterior adhesions of the iris or their ruptures, if they have already appeared. For this purpose, repeated instillation of mydriatics is used. It should be remembered that mydriatics can only be used when intraocular pressure is low (if intraocular pressure is elevated, it is better to use a 0,1% solution of adrenaline or a 1% solution of mesatone instead of these drugs). A swab moistened with one of these solutions is placed behind the lower eyelid. Then, repeated instillations of a solution of ofthandexamethasone or a 12% suspension of hydrocortisone are performed. At the same time, antibiotics are required.

Treatment depends on the etiology of the disease, with appropriate antibiotic therapy and topical corticosteroids. Be sure to prescribe vitamin therapy. With already formed posterior adhesions, the introduction of fibrinolysin, papain and a mixture of mydriatics by electrophoresis is recommended. When the inflammatory process subsides, resolving therapy, electrophoresis with aloe extract, lidase, and thermal procedures are indicated.

2. Hemeralopia

Hemeralopia (night blindness, night blindness) is a violation of twilight vision.

Etiology and pathogenesis. The causes of congenital hemeralopia have not been studied. Hemeralopia can be essential (of unknown etiology), beriberi or hypovitaminosis A, as well as beriberi B and PP can act as contributing factors. The appearance of symptomatic hemeralopia occurs with diseases of the retina and optic nerve. In the pathogenesis of the disease, the process of restoration of visual purpura plays a role.

clinical picture. Weakening of vision and spatial orientation at dusk. Decrease in light sensitivity, changes in electroretinogram, violation of the process of dark adaptation, narrowing of visual fields, especially in colors. The grounds for the diagnosis are complaints, the clinical picture, dark adaptation studies and electroretinography.

In the case of congenital hemeralopia, a persistent decrease in vision occurs. A favorable prognosis is noted for essential hemeralopia, in the case of symptomatic hemeralopia it depends on the course and outcome of the underlying disease.

Treatment and prevention. Congenital hemeralopia cannot be treated. With symptomatic hemeralopia, it is necessary to treat the underlying disease. With essential hemeralopia, the appointment of vitamin A inside is indicated: for adults, 50 IU / day, for children from 000100 to 000 IU / day. At the same time, riboflavin is prescribed (up to 1000 g / day). Prevention of essential hemeralopia is adequate intake of vitamin A.

Author: Shilnikov L.V.

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