iridocyclitis
Introduction
Introduction to iridocyclitis Anterioritis (also known as iridocyclitis), which often affects the ciliary body after inflammation of the iris, is clinically rare iritis or ciliary body is rare. Often at the same time. Anterior uveitis, also known as iridocyclitis, includes iritis, ciliary body inflammation, and iridocyclitis. Because the iris and ciliary body are anatomically interconnected, closely related, and the same is the iris ring, the iris and ciliary body are often inflamed at the same time. Iridocyclitis is one of the most common blinding eye diseases and is the most common type of uveitis. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: cataract glaucoma edema retinal detachment
Cause
Causes of iridocyclitis
Eye trauma factor (25%):
Eye trauma is a variety of pathological changes in the eyeball and its appendages caused by unforgettable mechanical physical or chemical damage from outside. It can cause bacteria, viruses, foreign bodies, chemicals, etc. to directly enter the eye and cause the iris ciliary body. inflammation.
Systemic disease (50%):
Systemic diseases can cause damage to various organs of the body, such as heart, lung, liver, brain, etc. Other parts such as cervical lymph, meninges, peritoneum, intestines, skin, bones, etc. can also be infected. Such as tuberculosis, leprosy, rheumatism, helicobacteria, etc. are more important causes of iridocyclitis.
Other factors (10%):
Other ocular tissues are adjacent to the iris, and other ocular tissues such as keratitis and scleritis may also cause the disease.
Prevention
Iridocyclitis prevention
Some patients in the early stage of the disease only showed red eyes, no obvious eye pain and decreased vision. Therefore, they often did not pay attention to it. They did not go to the hospital for treatment in time, or went to the pharmacy to buy eye drops. Some people also went to some specialist equipment. Poor medical unit treatment, because there is no necessary ophthalmic equipment such as slit lamp and other inspection equipment, so that the patient's slight anterior chamber opacity or corneal metaplasia can not be found, easily misdiagnosed as "red eye disease", because it was not timely It is not uncommon in clinical practice to have complications such as glaucoma such as dilated sputum. Of course, some patients go to a larger medical unit and are misdiagnosed as red eye disease because they have not been examined carefully or have not been examined for slit lamp. It also happens from time to time. Therefore, for "red eye", don't just consider "red eye disease". The most important point in the treatment of this disease is dilated phlegm treatment. However, when atropine is dilated, especially for children, we must pay attention to oppression of the lacrimal sac. District, so as not to cause poisoning due to drug absorption, in addition, after the disease is "cure", some patients can Now recurrent, some incentives should be taken to avoid "cold, tonsillitis, rheumatism" and so on, usually living should be the law as to avoid over exertion and mental stress, once jealous pain appears to timely treatment and therapy.
Complication
Iris ciliary body complication Complications cataract glaucoma edema retinal detachment
1, corneal opacity: posterior elastic layer wrinkles and corneal epithelial vesicular keratitis lesions, late corneal banding.
2, post-iris adhesion: iritis, due to fibrinous exudation, causing adhesion between the pupil edge of the iris and the anterior capsule of the crystal, early adhesion can be opened with a dilating agent, if the exudate has been machined, the adhesion is firm, It is not easy to pull open with the dilating agent, or the part of the adhesion pupil is pulled out and the petal-like edge is not complete.
3. Seclusion of the pupil: After the iris is completely fibrotic, it can never be pulled open, and the iris of the pupil is completely adhered to the front surface of the crystal, and the water circulation before and after is interrupted.
4. Peripheral anterior synechia of iris or goniosynechia: adhesion of the peripheral iris or iris root to the posterior cornea due to increased posterior pressure or accumulation of exudate.
5. occlusion of pupil: A large amount of exudate is deposited in the pupil region 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. 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, and the formation of a complete cataract. .
8, secondary glaucoma: due to adhesion of the anterior chamber, pupillary atresia, coupled with acute inflammatory vasodilation, plasma leakage, increased viscosities of the anterior chamber water lead to elevated intraocular pressure, secondary to glaucoma.
9, fundus lesions: late stage or severe cases may be complicated by macular edema or cystic degeneration, or with optic disc vasculitis.
10, eyeball atrophy: exudation of the mechanized tissue near the ciliary body to form a fibrous membrane to pull the retinal detachment, destroying the ciliary body to reduce the secretion of aqueous humor, decreased intraocular pressure, and the ciliary body itself repeatedly becomes inflamed and becomes necrotic tissue, resulting in The eyeball shrinks and shrinks.
Symptom
Iris ciliary body inflammation symptoms Common symptoms Eyebrow bow pain Tear tear Photorefractive corneal opacity Visual dysfunction Horner syndrome Iris blue iris surface ash formation... Slow response Spontaneous intrabulb hemorrhage
First, the symptoms:
Pain, photophobia, tearing and vision loss are the main features of the disease.
The trigeminal nerve of the iris ciliary body is not slightly stimulated by toxicity. The contraction of the ciliary muscle and the pain caused by the compression of the swollen tissue can be reflected to the eyebrow and the cheek. The ciliary body has obvious tenderness, and the nighttime pain is exacerbated. Often accompanied by corneal inflammatory response and shame, tear vision can suddenly drop, due to intra-corneal edema, corneal depression and inflammatory exudation affect the entry of light, ciliary body is stimulated by inflammatory stimulation, causing false Myopia, advanced with macular edema and optic retinitis.
Second, the signs:
1, ciliary congestion: there is obvious ciliary congestion, severe cases can also form mixed congestion and conjunctival edema.
2, kerato-precipitates (KP): atrial edema inflammatory cells and pigments due to the temperature difference between the cornea and the surface of the iris, with the centrifugal force and gravity of the anterior chamber water convection adhesion after inflammation of the rough corneal endothelium That is, the posterior corneal deposit, the deposition of sediment is triangular in the lower part of the center of the cornea, the tip is facing the pupil area, the large particles are below, and the small particles are above.
According to the nature of inflammation, the weight of the exudate, the length of time, the size and shape, the number of different and different performance, large grayish white sheep-like KP is a characteristic of chronic inflammation; small gray dusty KP is more common in acute or allergic granulation For swollen diseases, white KP can also be seen in some normal people, and the performance of no iritis is physiological KP. Therefore, it should be combined with other clinical signs for differential diagnosis.
3, aqueous humor: due to inflammation caused by increased protein content in the aqueous humor, aqueous humor mixed, in the aqueous light under the slit lamp is a light color reflective reflective zone, named Tyndall sign, expressed as active inflammation signs, severe can appear Fibrinous and purulent exudate, deposited in the lower part of the anterior chamber due to gravity, shows a apex hypophage. If the blood vessel ruptures, red blood cells overflow, resulting in hyphema.
4, the iris texture is unclear: when iritis, iris vasodilation followed by edema infiltration, darkening of the color, iris surface texture is unclear, in the granulomatous iridocyclitis, can see the iris nodules, deep and Shallow two, deep in the pupil edge is a translucent small gray group called koeppew nodules, more common in the early stage of subacute or chronic inflammation, the number varies, can disappear within a few days, shallow nodules in the iris roll Near the retraction, it is the Busacca nodule. This nodule can disappear quickly. Occasionally, aging and neovascularization can form. When the inflammation recurs, the iris shrinks and the surface forms a mechanical membrane and a new blood vessel. status.
5, pupil diminution: in the early stage of iris inflammation, due to iris congestion and edema, cell infiltration, and exudate toxin stimulate the pupil sphincter and open muscle contraction at the same time, showing dilated pupils, slow response to light.
6, vitreous opacity: ciliary body and vitreous adjacent, iris ciliary inflammatory fine dusty Egyptian flocculent exudate can invade the crystal posterior cavity and the front of the vitreous, making it turbid.
Examine
Examination of iridocyclitis
Check vision, fundus and intraocular pressure.
Diagnosis
Diagnosis and differentiation of iridocyclitis
diagnosis:
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis:
Acute conjunctivitis
Presenting acute onset, foreign body sensation, burning sensation, no secretion, examination of eyelid swelling, conjunctival hyperemia, these manifestations and acute anterior grape inflammation, photophobia, blurred vision, ciliary congestion and anterior chamber reaction are significantly different.
2. Acute angle-closure glaucoma
Acute onset, sudden loss of vision, headache, nausea, vomiting, corneal epithelial edema, anterior chamber anterior chamber, anterior chamber glint, etc., but no anterior chamber inflammatory cells, pupils with large oval spread, increased intraocular pressure, and acute anterior grapes Membrane inflammation of the cornea is transparent, a large number of KP, normal anterior chamber depth, a large number of inflammatory cells in the aqueous humor, dilated pupils, normal or low intraocular pressure signs are easy to identify.
3. Identification with intraocular tumors
Some intraocular metastases of primary intraocular tumors or tumors can cause changes such as atrial empyema, but they can be distinguished from medical history, clinical examination of systemic lesions, X-ray, ultrasound, CT and other nuclear magnetic resonance examinations. .
4. Identification of total uveal inflammation that can cause anterior uveal inflammation
Some types of uveitis, such as Behcet's disease uveal inflammation, Vogt-Koyanagihara disease, etc. can be manifested as total uveitis, so pay attention to identification in the diagnosis.
