acute iridocyclitis
Introduction
Introduction to acute iridocyclitis Iridocyclitis is also known as anterior uveitis. The inflammation of the iris often affects the ciliary body, so clinically separate iritis or ciliary body inflammation is rare. Often at the same time. There are many causes of iridocyclitis. In addition to ocular trauma, bacteria, viruses, foreign bodies, chemicals, etc. directly enter the eye and cause inflammation. Systemic diseases such as tuberculosis, leprosy, rheumatism, and helicobacteria cause iridescent eyelashes. An important cause of stomach inflammation. Other ocular tissues adjacent to the iris and ciliary body, such as keratitis and scleritis, can also cause the disease. basic knowledge The proportion of the disease: the prevalence rate is 50% - 60% of the whole uveitis Susceptible people: no specific population Mode of infection: non-infectious Complications: cataract glaucoma edema retinal detachment
Cause
Causes of acute iridocyclitis
Virus infection (35%):
There are many causes of iridocyclitis. In addition to ocular trauma, bacteria, viruses, foreign bodies, chemicals, etc. directly enter the eye and cause inflammation. Systemic diseases such as tuberculosis, leprosy, rheumatism, and helicobacteria cause iridescent eyelashes. An important cause of stomach inflammation.
Bad health habits (26%):
Poor hygiene practices such as rubbing your eyes with your hands, sharing towels, face washes, faucets, door handles, swimming pool water, and public toys are also factors contributing to the disease.
Other eye inflammation (25%):
Other ocular tissues adjacent to the iris and ciliary body, such as keratitis and scleritis, can also cause the disease.
Prevention
Acute iridocyclitis prevention
1, the patient should bring their own 1% atropine eye drops, once the eye appears red, pain and other repeated performance of the disease, you can use 1% atropine eye drops before going to the hospital for treatment;
2, should strengthen physical exercise and enhance physical fitness;
3, go out to wear ink;
4, should keep the stool smooth, drink more water in the acute phase.
Complication
Acute iridocyclitis complications 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 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. 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
Acute iridocyclitis symptoms Common symptoms Iris surface formation ash... Horner syndrome iris granuloma faint light tears reaction dull visual impairment keratitis eyebrow pain
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, physical 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 acute iridocyclitis
Check your eyesight, fundus and eye pressure.
Diagnosis
Diagnosis and diagnosis of acute iridocyclitis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Acute conjunctivitis: Conjunctival hyperemia, decidua hyperplasia, follicular formation, increased secretion, but KP negative, room flash negative, normal pupil, normal vision.
2. Acute angle-closure glaucoma: ciliary congestion, or mixed congestion, corneal edema, anterior chamber shallowing, dilated pupils, increased intraocular pressure, and the anterior chamber of the disease is normal, the pupil is narrowed, and the intraocular pressure is generally normal or decreased. Elevation occurs only when the exudate blocks the anterior corner or the pupil is locked.
