Secondary glaucoma with iridocyclitis
Introduction
Introduction to secondary glaucoma with iridocyclitis Secondary glaucoma is a complication of some eye diseases and some systemic diseases in the eye. This kind of glaucoma has many kinds of clinical manifestations, and its clinical manifestations have their own characteristics. The treatment principles are also different, and the prognosis is also very different. Most occur in young adults, mostly unilateral, the cause is unknown, may be related to increased secretion of prostaglandins, prostaglandin E increases in the acute water in the acute attack, prostaglandins can destroy the blood barrier, blood vessels change permeability, aqueous humor increase. basic knowledge The proportion of illness: 0.0025% Susceptible people: no specific population Mode of infection: non-infectious Complications: cataract malignant glaucoma retinal detachment
Cause
Causes of secondary glaucoma with iridocyclitis
Caused by chronic iridocyclitis (30%):
Can be seen in the following three cases: 1 post-iris adhesion causes pupillary membrane closure, pupillary atresia, iris bulging, anterior chamber angle closure; 2 various inflammatory cells, exudates, pigment particles and other retention in the anterior chamber angle, can be produced Adhesion around the corner of the corner, hindering the outflow of aqueous humor; 3 inflammation can lead to reddening of the iris, peripheral adhesions and neovascular glaucoma.
Acute iridocyclitis caused by (28%):
Secondary open-angle glaucoma caused by acute iridocyclitis, usually with acute iritis, the formation of aqueous humor is reduced, but the amount of outflow has not changed, so the intraocular pressure drops, but sometimes the opposite occurs. As the inflammatory product blocks the trabecular meshwork, or the viscosity of the aqueous humor increases, the outflow of aqueous humor decreases and the intraocular pressure increases.
Glaucoma ciliary inflammatory syndrome (25%):
Most occur in young adults, mostly unilateral, the cause is unknown, may be related to increased secretion of prostaglandins, prostaglandin E increases in the acute water in the acute attack, prostaglandins can destroy the blood barrier, blood vessels change permeability, aqueous humor increase.
Prevention
Secondary glaucoma prevention with iridocyclitis
Early detection of early treatment, especially for people over the age of 40 with a family history of glaucoma, should be done on an annual basis. Pay attention to rest and sleep, avoid overwork and emotional excitement, and read or engage close-up workers with sufficient light.
1. Physical exercise should be strengthened to enhance physical fitness.
2. Wear sunglasses when going out.
3. The stool should be kept open. Drink more water during the acute phase.
Complication
Secondary glaucoma complications with iridocyclitis Complications, cataract, malignant glaucoma, retinal detachment
1. Corneal opacity: posterior elastic layer wrinkles and corneal epithelial vesicular keratitis lesions, before the corneal banding occurs in the late stage,
2. Post-iris adhesion: In iritis, due to fibrinous exudation, adhesion between the pupil edge of the iris and the anterior capsule of the iris occurs. The early adhesion can be opened by the dilating agent. If the exudate has been machined, the adhesion is firm. It is not easy to pull open with a dilating agent, or the part of the adhesion pupil is pulled out and the petal-like edge is not finished.
3. The seclusion of the pupil is completely unfolded after the fibrosis of the iris, and the iris of the pupil is completely adhered to the front surface of the crystal, and the circulation of the front and rear water is interrupted.
4. Peripheral anterior synechia of iris or gonio synechia, due to increased posterior atrial pressure or accumulation of exudate, causing adhesion of the surrounding iris or iris root to the posterior cornea.
5. occlusion of pupil: a large amount of exudate deposits in the pupil area to form a film covering the front surface of the crystal.
6. Iris bombe: Since the aqueous humor cannot flow forward from the posterior chamber, it is blocked in the posterior chamber, which increases the pressure in the posterior chamber. The accumulation of aqueous humor causes the iris to move forward and expand.
7. Concurrent cataract: When the iris is inflamed, the nature of the aqueous humor changes, and the inflammatory toxicity in the aqueous humor changes the external environment of the crystal, which also changes the normal physiological metabolism of the crystal, leading to opacity of the anterior and posterior cortex of the crystal, and the formation of a complete cataract. ,
8. fundus lesions: late stage or severe cases may be complicated by macular edema or cystic degeneration, or with optic disc vasculitis.
9. Atrophy of the eyeball: exudative mechanized tissue near the ciliary body forms a fibrous membrane to pull the retinal detachment, destroying the ciliary body, reducing the secretion of aqueous humor, reducing the intraocular pressure, and repeatedly causing the ciliary body itself to become necrotic tissue, resulting in The eyeball shrinks and shrinks,
In addition, complications such as anterior chamber bleeding, anterior chamber formation delay or no anterior chamber, secondary iridocyclitis, malignant glaucoma, etc., occur after glaucoma surgery.
Symptom
Secondary glaucoma symptoms with iridocyclitis Common symptoms Rainbow nausea
The onset is very urgent, there are typical glaucoma symptoms such as fog, rainbow, headache, and even nausea and vomiting. After the symptoms disappear, vision and vision are mostly harmless.
Examine
Examination of secondary glaucoma with iridocyclitis
During the examination, mild mixed congestion, corneal edema, a little coarse gray-white corneal effusion, a small anterior chamber, a shallow angle of the anterior chamber, mild turbidity in the aqueous humor, a slightly larger pupil, and a reaction to light, intraocular pressure Can be as high as 5.32-7.98kpa (40 ~ 60 mm Hg), no obvious changes in the fundus, normal optic disc, arterial pulsation can be seen when the intraocular pressure is high.
The disease is characterized by recurrent episodes, the duration of the episode is 3 to 7 days, and more can be relieved by itself. The interval between the episodes is from several months to 1-2 years.
Diagnosis
Diagnosis and diagnosis of secondary glaucoma with iridocyclitis
The disease is often confused with acute angle-closure glaucoma, which can be identified according to the characteristics of lighter age, less anterior chamber, typical gray-white KP, open angle of the anterior chamber, and generally no damage to the posterior visual function.
