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24. Irit
Iritis is an inflammatory process in the iris.
The introduction of infection into the eye during injuries, various diseases (flu, diseases of the teeth and tonsils, tuberculosis, rheumatism, brucellosis, etc.). 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. A characteristic sign of iritis is a change in the color of the iris. To get a clear picture of this change, it is recommended to examine the iris in natural light, comparing the color in one eye and the other. The gray and blue iris takes on a green or rusty tint, and the brown iris 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.
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.
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.
Author: Shilnikov L.V.
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