Like any other organ of the human body, the eye needs constant nutrition, oxygenation (saturation with oxygen, which is bound and delivered by red blood cells) and cleansing of residual metabolic products (processing and metabolism). All these functions are assigned by evolution to the circulatory system.
The circulatory system of the eye is quite complex. The choroid, which includes “standard” arteries (fresh blood), capillaries (direct blood supply to tissues) and veins (outflow of waste blood), includes three relatively independent functional blocks. The anterior section includes the iris, followed by the ciliary or ciliary body (a complex formation that is also responsible for the processes of accommodation) and, finally, the posterior block is formed by the choroid - the choroid itself, feeding the structures of the fundus of the eye (retina, optic nerve head).
Under special unfavorable conditions, the ocular vascular system becomes inflamed. Pathogenic factors include, first of all, infections (viral, bacterial, fungal), systemic diseases (rheumatism, ankylosing spondylitis, etc.), and previous eye injuries. Hereditary predisposition also plays a role. In a significant proportion of cases (up to 30%), the cause remains unknown.
The general name for inflammation in the circulatory system of the eye is uveitis (from the ancient Greek “uvea” - grape, bunch). Special cases of uveitis are also distinguished, guided, first of all, by the criterion of preferential localization of the process. Thus, inflammation of the choroid of the fundus of the eye is called choroiditis, inflammation of the ciliary body is called cyclitis, inflammation of the iris is called iritis. However, inflammation rarely remains isolated, usually managing to spread to neighboring structures before detection and treatment.
Thus, iridocyclitis, one of the most common variants of anterior uveitis, is a mixed form of inflammation of the ocular blood vessels involving both the ciliary body and the iris. This process can develop in any age category, but the most susceptible group, as statistics show, are people aged 20-40 years, i.e. the most active and able-bodied part of the population.
Iridocyclitis: causes of occurrence
Inflammation of the iris can occur for various reasons. For example, it becomes a consequence of chronic infection in the nasopharynx or oral cavity. Endogenous iridocyclitis occurs as a complication of bacterial, viral, and fungal diseases. Often it also develops with various systemic pathologies of the body: rheumatism, arthritis, gout, etc.
Exogenous iridocyclitis can occur due to penetrating eye injuries, after surgery, and also be a consequence of inflammatory diseases. Provoking factors are important: hypothermia, severe physical activity, stressful situation, endocrine disorder.
Causes and provoking factors of iridocyclitis
As a rule, iridocyclitis develops against the background of chronic infections, both general and local (especially in the presence of lesions in the nasopharynx and oral cavity). Pathogenic pathogens can be viruses (herpes, cytomegalovirus, measles, influenza), pathogenic bacteria (brucellosis, syphilis, tuberculosis and many others), protozoan microorganisms and intracellular parasites (chlamydia, toxoplasmosis, malaria), fungal cultures (candidiasis, etc. ).
Systemic inflammation of the joints (rheumatoid arthritis, ankylosing spondylitis) often provokes the development of iridocyclitis. The listed forms of iridocyclitis are called endogenous (due to internal causes).
Exogenous (brought from outside) variants of iridocyclitis usually turn out to be complications of injuries, including ophthalmic surgery, and acute infectious and inflammatory processes in the cornea or sclera. Provoking factors in such cases are usually hypothermia, physical or emotional overload, and endocrine disorders.
Symptoms of iridocyclitis of the eye
At the onset of the disease, a person experiences pain in the area of the affected eye and temple, as well as lacrimation, photophobia, and deterioration of vision. Signs of this eye pathology: dilation of blood vessels around the limbus, change in the shade of the iris, smoothing of its pattern. Thus, blue eyes acquire a greenish tone, gray ones become dirty green, and the brown iris appears to be a shade of rust.
Outwardly noticeable are blood clots in the anterior chamber of the eye, as well as exudate, which can be serous, fibrinous or purulent - from this content the corresponding form of iridocyclitis is called. The vitreous body becomes cloudy due to the release of exudate.
Purulent discharge may settle to the bottom of the anterior chamber of the eye. If the dilated vessel ruptures, a blood clot will appear - a hyphema. The iris tissue becomes saturated with exudate, for this reason it becomes thicker and the pupil narrows. If the disease progresses unfavorably, the pupil becomes irregular in shape or may become completely closed.
External signs of the disease depend on its etiology and the state of the immune system. Each type of iridocyclitis is characterized, in addition to the general ones, by its own symptoms. So, if it arose as a complication from a virus, the exudate is serous-fibrinous, and the course of the disease is torpid - very slow. With tuberculosis, tubercles (granulomas) are formed, and adhesions often occur. Infectious iridocyclitis develops very quickly and acutely, but also passes faster. Autoimmune types are characterized by relapses and complications: cataracts, glaucoma. The inflammatory process can also spread to the posterior parts of the choroid, cornea, and sclera. In especially severe cases, the eyeball atrophies. Iridocyclitis, which occurs due to penetrating trauma to the visual organ, can also affect the healthy eye - this is called sympathetic inflammation.
Clinic and diagnostics
Acute infectious iridocyclitis usually affects one eye (and, in the absence of timely adequate treatment, can spread to the second).
In systemic diseases, such as autoimmune diseases, both eyes are usually affected simultaneously.
Typical symptoms include intense pain in the affected eye (palpation is especially painful), redness, increased lacrimation, and a painful reaction to bright light. The pain may radiate to the temple or brow ridges. A relatively mild decrease in visual clarity and acuity is also possible.
An ophthalmoscopic examination reveals dilation of the pericorneal (located around the limbus) vessels, which causes the characteristic redness.
The transparency of the corneal layer is usually not lost, however, precipitates are sometimes found on the back layers - peculiar sedimentary fine-grained accumulations of cells that have died due to inflammation; if present, precipitates are considered one of the most specific objective symptoms for iridocyclitis.
In serous and exudative forms, there is often turbidity of the fluid in the anterior eye chamber, sometimes with blood inclusions, as well as with the presence of exudate itself, pus or fibrinous fibers; settling, such inclusions form a characteristic crescent or stripe with a gray or yellowish surface at the bottom of the anterior chamber (the so-called hypopyon). Hyphema may occur - hemorrhage in the anterior chamber due to perforation of the wall of a vessel.
The appearance of the iris changes: the pattern becomes erased and seems to be tinted green or brownish-red. In most cases, miosis (constriction of the pupil) is pronounced and the reaction to light is sharply weakened. If left untreated for a long time, an adhesive process may begin - synechiae (adhesions) occur between the inflamed iris and the anterior lens capsule. Adhesions can also form along the perimeter of the pupil, deforming it or even completely overgrowing it. The secretion of intraocular fluid by the ciliary body during iridocyclitis is inhibited (suppressed), so intraocular pressure is often reduced. However, with an advanced adhesive process, drainage (removal of fluids) is mechanically hampered, as a result of which at this stage the IOP may be increased.
In general, the clinical picture, dynamics and prognosis of iridocyclitis are determined by the nature of the pathogenic factor and, to a large extent, by the general immune status of the patient.
Iridocyclitis is diagnosed by the presence and combination of the subjective and objective symptoms listed above. Such inflammation must be differentiated from similar variants of uveitis and other intraocular infectious or infectious-allergic diseases, since the symptoms can be very similar.
For the purposes of ascertaining, clarifying and differential diagnosis, both laboratory and instrumental methods (clinical and biochemical blood tests, visualization examinations of the maxillofacial area and/or chest to identify infectious foci, etc.) are informative. In some cases, consultation with related specialists is necessary, in particular, an endocrinologist, an infectious disease specialist, an ENT doctor, a dentist, a phthisiatrician, etc.
How is iridocyclitis diagnosed?
To establish the cause of the disease, a comprehensive examination of the patient is performed. It includes various verification methods:
- X-ray;
- clinical tests;
- immunological examination.
Diagnosis is carried out in a hospital. The eyes are also examined using a slit lamp and palpation. Usually the pupil is constricted and does not respond well to light. Often it has an irregular shape.
A visual examination allows you to determine a change in the color of the iris compared to a healthy eye. After collecting all the data, the doctor determines the cause of iridocyclitis. In some cases, it is of unknown etiology. Intraocular pressure during iridocyclitis is usually reduced, but if fusion of the anterior capsule of the lens and the iris occurs, the normal process of outflow of intraocular fluid is disrupted. This condition can lead to increased intraocular pressure, and, as a result, to the development of secondary glaucoma.
A comparative analysis with other eye diseases with similar symptoms, for example, conjunctivitis, is also required. If necessary, consultations with other specialized specialists are prescribed: dentist, otolaryngologist, endocrinologist, phthisiatrician, allergist, infectious disease specialist.
Iridocyclitis - symptoms and treatment
Treatment of patients, regardless of the cause of the disease, is aimed at performing several tasks:
- eliminate signs of inflammation;
- maintain or restore visual functions;
- prevent relapses of the disease (if possible).
Often the timing of clinical and true recovery does not coincide. For example, the symptoms of iridocyclitis disappear, but laboratory signs of inflammation persist. The body needs time for its immune system to cope with an agent foreign to it. The disease is also characterized by residual effects, which the patient is able to cope with on his own, continuing treatment on an outpatient basis or even at home, strictly following the recommendations of his attending physician.
Since the pathogenesis of iridocyclitis is based on many factors, therapy takes into account the causes of the disease, immune status and activity of the process [5].
Treatment includes targeting two main components of inflammation:
- increased permeability of the walls of blood vessels of the blood-ophthalmic barrier (“obstacles” to the path of the virus into the vessels of the eye);
- the appearance of exudate in tissues, further destruction and excessive fibrosis against the background of immunity disorders and the general condition of the body.
Drug treatment
After diagnosis, as a rule, first of all, anesthetics, mydriatic drugs that dilate the pupil (atropine), antibiotics (cephaosporins, fluoroquinolones), non-steroidal anti-inflammatory drugs (diclofenac, bromfenac, nepafenac) are prescribed. Local use of steroid drugs (dexamethasone) is more effective in acute iridocyclitis.
General treatment includes:
- sanitization (cleaning) of foci of infection;
- taking antibiotics;
- nonspecific and specific anti-inflammatory therapy (anti-tuberculosis, antiviral drugs);
- vitamin therapy;
- hyposensitizing therapy (reducing sensitivity to the allergen).
When the body's defenses are weak and the amount of immunoglobulins (antibodies that fight viral antigens) in the blood serum is reduced, immunostimulants (poludanum, dalargin), vaccination, etc. are sometimes indicated.
The combination of treatment aimed at eliminating the cause and therapy that suppresses the mechanisms of disease development (i.e., the use of antibacterial, anti-inflammatory, antiviral, immunomodulatory drugs) helps to reduce and disappear the symptoms of the disease, normalize laboratory parameters and shorten treatment time [7].
Surgical treatment
If complications develop, surgical treatment may be prescribed: excision of adhesions, iridectomy, laser surgery.
Physiotherapy
Physiotherapy is rarely used in the treatment of iridocyclitis. UHF therapy, magnetic therapy, UV radiation, etc. can be used.
UHF therapy is exposure to an electric field of ultra-high frequencies. This generates heat, which reduces inflammation and spasms and stimulates blood and lymph flow. Magnetic therapy uses a constant or pulsed magnetic field. It improves blood microflow, metabolic processes, reduces swelling and pain.
Treatment of iridocyclitis in a hospital
If daily injections are required, treatment in a hospital or day hospital may be offered with daily examinations by the attending physician and assessment of the dynamics of the process.
Treatment of iridocyclitis with folk remedies
The effectiveness of treating iridocyclitis with traditional methods has not been scientifically proven. Without adequate treatment, the disease can lead to complications such as glaucoma and cataracts.
Iridocyclitis: treatment methods
Drops that dilate the pupil are prescribed as first aid. The specialist prescribes medications that act on the causative agent of infection, increase immunity, and eliminate inflammation. Usually these are drugs that contain antibiotics. Corticosteroids, cytostatics, immunomodulators, enzyme agents, and absorbable exudates can be used.
With timely initiation of therapy, the prognosis is favorable. If treatment is prescribed late or the disease is severe, then various consequences are possible: sympathetic inflammation of the second eye, glaucoma, atrophy of the eyeball, blindness.
Symptoms
Main symptoms of iridocyclitis: 3
- Change in the iris: it changed color, the contours became blurry.
- Aching pain in the eye, often “radiates” to the area of the nose, cheeks, teeth, temple and forehead: it intensifies when the pupil constricts in bright light.
- Photophobia: You feel discomfort and pain in the eye when exposed to bright light.
- Eye redness: The eye becomes red due to vasodilation.
- Decreased vision: any deviation from your normal.
- Watery eyes: Tears constantly flow for no reason.
When examining patients with iridocyclitis, ophthalmologists see redness of the eye, deposits on the inside of the cornea, narrowing and irregular shape of the pupil. Cloudiness of the anterior chamber may be observed. The iris thickens due to vasodilation and inflammatory edema, which leads to a sluggish reaction to light. Some patients also have difficulty opening their eyes (blepharospasm). 4
Treatment of iridocyclitis
Successful treatment of iridocyclitis is determined by the correct diagnosis.
To do this, it is necessary to take general blood and urine tests - this will allow you to exclude certain foci of pathology and refer the patient for a more detailed examination to a specialist.
Remember! Treatment of iridocyclitis is a long process that must be approached comprehensively.
The main goal of such treatment is the relief of inflammatory symptoms and the resorption of exudate formed in the anterior ocular chamber.
In such cases, medications that dilate the pupil, hormonal ointments and drops , as well as antibiotics .
During the treatment process, physiotherapeutic procedures should be regularly performed , which contribute to the rapid resorption of purulent formations and help relieve inflammation.
Iridocyclitis and its types
Typically, inflammation affects three systems at once : vascular, iris and ciliary.
Individually, such diseases are quite rare , so if at least one of the symptoms is detected, it is necessary to begin comprehensive treatment.
Otherwise, a decrease in visual acuity or its complete loss is predicted.
Inflammations are visible in the anterior membrane of the eye and can occur in people in the middle age category (25-45 years).
Depending on the cause, nature and course of the disease, it is divided into types:
- non-infectious-allergic;
- infectious-allergic;
- iridocyclitis caused by trauma;
- a disease that develops due to systemic disorders .
Attention! If we talk about the causes, the disease may not have a clear origin, and may also be caused by various ophthalmological diseases.
According to its course, the disease is classified as follows:
- chronic;
- acute;
- subacute;
- recurrent form.
Iridocyclitis is also divided into categories - hemorrhagic, fibroplastic, exudative and serous .
Acute iridocyclitis
In the acute form, the disease begins to develop sharply with the manifestation of painful symptoms that occur in the affected eye.
The pain can be localized exclusively in the visual area, but often spreads throughout the head .
Causes
Ophthalmologists distinguish several types of causes, among which there are both external and internal factors.
In the first case, the main cause can be considered various injuries of a domestic or surgical nature . Among the diseases that lead to the disease are Reiter's syndrome, sarcoidosis, and ankylosing spondylitis .
Iridocyclitis can also be caused by the following underlying diseases:
- different types of diabetes ;
- inflammation of the iris , having different origins;
- herpes;
- inflammation of the paranasal sinuses;
- measles;
- toxoplasmosis;
- tonsillitis.
Carefully! With a developed vascular system of the eye, which is itself a pathology, the likelihood of the disease increasing significantly.
Possible complications
If iridocyclitis is not treated properly, the following complications may occur: 8
- Cataract. Most often develops with a long course of the disease.
- Irregular pupil shape. Scar tissue can cause the iris to fuse with the lens.
- Glaucoma. Recurrent iridocyclitis can lead to this incurable disease.
- Calcium deposits on the cornea. They provoke corneal degeneration, which impairs vision.
- Swelling inside the retina. Fluid-filled cysts in the back of the eye can reduce your central vision.
