Chronic iridocyclitis

Tuberculous iridocyclitis is characterized by a relapsing course.

Exacerbations are usually caused by activation of the underlying disease. The inflammatory process begins sluggishly. Pain syndrome and hyperemia of the eyeball are weakly expressed. The first subjective symptoms are decreased visual acuity and the appearance of floating "flies" before the eyes. During examination, multiple large "greasy" precipitates are noted on the back surface of the cornea, newly formed vessels of the iris, opalescence of the fluid of the anterior chamber, opacities in the vitreous body. Tuberculous iridocyclitis is characterized by the appearance of yellowish-gray or pink inflammatory tubercles (granulomas) along the pupillary edge of the iris, to which newly formed vessels approach. These are metastatic foci of infection - true tuberculosis. Mycobacterium tuberculosis can be introduced both in the primary and post-primary stages of tuberculosis. Tubercles in the iris can exist for several months and even several years, their size and number gradually increasing. The process can spread to the sclera and cornea.

In addition to true tuberculous infiltrates, small "flying" guns resembling flakes of cotton wool, located superficially, periodically appear and quickly disappear along the edge of the pupil. These are peculiar precipitates settling on the very edge of a sluggish, slightly mobile pupil. Chronic iridocyclitis is characterized by the formation of coarse synechiae. In an unfavorable course of the disease, complete fusion and overgrowth of the pupil occur. Synechiae can be planar. They lead to complete immobility and atrophy of the iris. In such cases, newly formed vessels move from the iris to the surface of the overgrown pupil. Currently, this form of the disease is rare.

The diffuse form of tuberculous iridocyclitis occurs without the formation of tubercles in the form of a persistent, often aggravating plastic process with characteristic "greasy" precipitates and fluff located along the edge of the pupil.

Accurate etiological diagnosis of tuberculous iridocyclitis is difficult. Active pulmonary tuberculosis is extremely rarely combined with metastatic tuberculosis of the eyes. Diagnosis should be carried out jointly by a phthisiologist and an ophthalmologist, taking into account the results of skin tuberculin tests, the state of immunity, the nature of the course of the general disease and the characteristics of eye symptoms.

Brucellosis iridocyclitis

Usually occurs in the form of chronic inflammation without severe pain, with weak pericorneal injection of vessels and pronounced allergic reactions. The clinical picture includes all the symptoms of iridocyclitis, but at first they develop unnoticed and the patient consults a doctor only when he or she notices deterioration of vision in the affected eye. By that time, there is already fusion of the pupil with the lens. The disease can be bilateral. Relapses occur over several years.

To establish the correct diagnosis, anamnestic data on contact with animals and animal products in the past or at present, indications of arthritis, orchitis, spondylitis suffered in the past are very important. The results of laboratory tests are of primary importance - positive Wright and Huddleson reactions. In latent forms of the disease, it is recommended to perform the Coombs test.

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Herpetic iridocyclitis

One of the most severe inflammatory diseases of the iris and ciliary body. It does not have a characteristic clinical picture, which in some cases complicates diagnosis. The process can begin acutely with the onset of severe pain, severe photophobia, bright pericorneal injection of vessels, and then the course becomes sluggish and persistent. The exudative reaction is often serous, but can also be fibrinous. Iridocyclitis of herpetic origin is characterized by a large number of large precipitates merging with each other, swelling of the iris and cornea, the appearance of hyphema, and decreased sensitivity of the cornea. The prognosis significantly worsens when the inflammatory process moves to the cornea - keratoiridocyclitis (uveokeratitis) occurs. The duration of such an inflammatory process, capturing the entire anterior part of the eye, is no longer limited to several weeks, sometimes it drags on for many months. If conservative measures are ineffective, surgical treatment is performed - excision of the melting cornea containing a large number of viruses, and therapeutic transplantation of a donor graft.

Features of some forms of acute iridocyclitis

Influenza iridocyclitis usually develops during a flu epidemic. The disease begins with the onset of acute pain in the eye, then all the characteristic symptoms quickly appear. Each season, the course of the disease has its own characteristics, which are manifested primarily in the nature of the exudative reaction, the presence or absence of a hemorrhagic component, and the duration of the disease. In most cases, with timely treatment, the outcome is favorable. There are no traces of the disease in the eye.

Rheumatic iridocyclitis occurs in an acute form, is characterized by periodically occurring relapses, accompanies joint attacks of rheumatism. Both eyes can be affected simultaneously or alternately.

The clinical picture is characterized by bright pericorneal injection of vessels, a large number of small light precipitates on the posterior surface of the cornea, opalescence of the anterior chamber fluid, the iris is flaccid, edematous, the pupil is constricted. Superficial epithelial posterior synechiae are easily formed. The exudate is serous in nature, a small amount of fibrin is released, therefore strong adhesions of the pupil do not form. Synechiae are easily torn. The duration of the inflammatory process is 3-6 weeks. The outcome is usually favorable. However, after frequent relapses, the severity of signs of iris atrophy gradually increases, the pupil's reaction becomes sluggish, first marginal and then planar adhesions of the iris with the lens are formed, the number of thickened fibers in the vitreous body increases, and visual acuity decreases.

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