Chronic iridocyclitis

Tuberculosis iridocyclitis is characterized by a recurrent course.

To exacerbations usually activates the underlying disease. The inflammatory process starts sluggishly. Pain and hyperemia of the eyeball are weak. The first subjective symptoms are reduced visual acuity and the appearance of floating flies in front of the eyes. When examined, there are multiple large "sebaceous" precipitates on the posterior surface of the cornea, newly formed vessels of the iris, opalescence of the anterior chamber, opacification in the vitreous. For tuberculous iridocyclitis, the appearance of yellowish-gray or pink inflammatory tubercles (granuloma) is characteristic along the pupil margin of the iris, to which the newly formed vessels are suitable. These metastatic foci of infection are true tuberculosis. Mycobacterium tuberculosis can be entered both in the primary and in the post-primary stage of tuberculosis. Bumps in the iris can exist for several months and even for several years, the size and number of them gradually increase. The process can pass to the sclera and the cornea.

In addition to true tuberculous infiltrates, "flying" small cannon appearing on the edge of the pupil and disappearing quickly, resembling flakes of cotton, which are superficially distributed. This is a kind of precipitates that settle at the very edge of a sluggish, slow-moving pupil. For chronic iridocyclites, the formation of coarse synechia is characteristic. In the unfavorable course of the disease, complete fusion and infection of the pupil occur. The synechia can be planar. They lead to complete immobility and atrophy of the iris. Newly formed vessels in such cases pass from the iris to the surface of the infected pupil. Currently, this form of the disease is rare.

Diffuse form of tuberculous iridocyclitis proceeds without the formation of tubercles in the form of a stubborn, often exacerbated plastic process with characteristic "greasy" precipitates and guns located along the edge of the pupil.

The exact etiologic diagnosis of tuberculosis iridocyclitis is difficult. Active pulmonary tuberculosis is extremely rarely combined with metastatic eye tuberculosis. The diagnosis should be carried out jointly by a phthisiatrist and an ophthalmologist taking into account the results of cutaneous tuberculin samples, the state of immunity, the nature of the course of the general disease and the features of the ocular symptomatology.

Brucellosis iridocyclitis

Usually occurs in the form of chronic inflammation without severe pain, with mild pericorneal injection of vessels and marked allergic reactions. In the clinical picture, all the symptoms of iridocyclitis are present, but at first they develop imperceptibly and the patient consults the doctor only when he detects vision deterioration in the affected eye. By that time there is already a fusion of the pupil with the lens. The disease can be bilateral. Relapses occur within a few years.

To establish the correct diagnosis, it is very important to have anamnestic data on contact with animals and livestock products in the past or at present, indications of past arthritis, orchitis, spondylitis. The main importance is the results of laboratory studies - the positive reactions of Wright, Huddlson. For latent forms of the disease, it is recommended to perform a Coombs test.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Herpetic iridocyclitis

One of the most severe inflammatory diseases of the iris and the ciliary body. It does not have a characteristic clinical picture, which in some cases makes diagnosis difficult. The process can begin acutely with the emergence of severe pain, severe photophobia, a bright pericorneal injection of blood vessels, and then the flow becomes sluggish and stubborn. The exudative reaction is more often serous, but it can also be fibrinous. Iridocyclitis of herpetic nature is characterized by a large number of large merging precipitates, puffiness of the iris and cornea, the appearance of hyphae, a decrease in the sensitivity of the cornea. The prognosis worsens significantly when the inflammatory process changes to the cornea - keratouridocyclitis (uveokeratitis) occurs. The duration of such an inflammatory process that captures the entire front of the eye is no longer limited to a few weeks, sometimes it lasts for many months. When conservative measures are ineffective, surgical treatment is performed - excision of a melting cornea containing a large number of viruses and a therapeutic transplant of the donor transplant.

Features of some forms of acute iridocyclitis

Influenza iridocyclitis usually develops during the flu epidemic. The disease begins with the onset of acute pain in the eye, then all the characteristic symptoms quickly appear. In 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 the hemorrhagic component, 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, characterized by recurrent relapses, accompanied by joint attacks of rheumatism. Both eyes can be affected simultaneously or alternately.

In the clinical picture, attention is drawn to the bright pericorneal injection of vessels, a large number of small light precipitates on the posterior surface of the cornea, the opalescence of the anterior chamber, the iris is flaccid, edematic, the pupil narrowed. It is easy to form superficial epithelial posterior synechiae. The character of the exudate is serous, a small amount of fibrin is released, so there is no strong fusion of the pupil. The synechia easily breaks. The duration of the inflammatory process is 3-6 weeks. The outcome is usually favorable. However, after frequent relapses, the signs of atrophy of the iris gradually increase, the sluggish response of the pupil becomes, first the marginal and then the plane fusion of the iris with the lens, the number of thickened fibers in the vitreous body increases, and the visual acuity decreases.

[10], [11], [12], [13], [14], [15], [16],