Treatment of acute and chronic iridocyclitis

Depending on the cause of the iridocyclitis of the inflammatory process, general and local treatment of iridocyclitis is carried out.

At the first examination of the patient it is not always possible to determine the cause of the occurrence of iridocyclitis. The etiology of the process can be established in the following days, and sometimes it remains unknown, but the patient needs emergency help: procrastination with the appointment of treatment even for 1-2 hours can seriously complicate the situation. The anterior and posterior chambers of the eye have a small volume, and 1-2 drops of exudate or pus can fill them, paralyze the fluid exchange in the eye, glue the pupil and the lens.

First aid

With inflammation of the iris and ciliary body of any nature, the first aid is aimed at the maximum dilatation of the pupil, which allows one to solve several problems at once. First, with the dilatation of the pupil, the vessels of the iris contract, therefore the formation of the exudate decreases and at the same time the accommodation becomes paralyzed, the pupil becomes immobile, thereby ensuring rest to the affected organ. Secondly, the pupil is diverted from the most convex central part of the lens, which prevents the formation of the posterior synechia and ensures the possibility of rupturing the already existing fusion. Third, a wide pupil opens the outlet to the anterior chamber for exudate accumulated in the posterior chamber, thereby preventing the adhesion of the processes of the ciliary body, as well as the spread of exudate into the posterior part of the eye.

To dilate the pupil, instill a 1% solution of atropine sulfate 3-6 times a day. With inflammation, the duration of mydriatic action is many times less than in a healthy eye. If the synechia is already found during the first examination, other mydriatic substances are added to atropine, for example an adrenaline solution of 1: 1000, a solution of mydriacil. To enhance the effect behind the eyelid lay a narrow strip of cotton wool soaked in mydriatic. In some cases, it is possible to put a dry atropine crystal behind the eyelid. Non-steroidal anti-inflammatory drugs in the form of drops (tilt, diclof, indomethacin) enhance the action of mydriatic. The number of combined mydriatics and instillations in each specific case is determined individually.

The next measure of an ambulance is a subconjunctival injection of steroid preparations (0.5 ml of dexamethasone). With purulent inflammation under the conjunctiva and intramuscularly injected with a broad-spectrum antibiotic. To eliminate pain, prescribe analgesics, klubelno-orbital novocaine blockades.

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

Treatment of acute iridocyclitis

After clarifying the etiology of iridocyclitis, sanation of identified foci of infection is carried out, a scheme of general treatment is developed, assigning funds that affect the source of infection or toxic-allergic effects. Conduct a correction of the immune status. As necessary, they use analgesics and antihistamines.

With local treatment of iridocyclitis, a daily correction of the therapy is necessary depending on the reaction of the eye. If by means of usual instillations it is not possible to break the rear synechia, enzyme therapy (trypsin, lidazum, lekosim) in the form of parabulbar, subconjunctival injections or electrophoresis is additionally prescribed. It is possible to use medical leeches in the temporal region from the side of the affected eye. The pronounced anesthetic and anti-inflammatory effect gives a course of the pterygoal-orbital blockades with steroidal, enzymatic preparations and analgesics.

With abundant exudative reaction, posterior synechia can form even with the dilatation of the pupil. In this case, it is necessary to abolish mydriatica in a timely manner and briefly assign myotics. Once the spikes have come off and the pupil is narrowed, the mydriatica ("pupil gymnastics") is again appointed. After achieving sufficient mydriasis (6-7 mm) and rupture of synechia, atropine is replaced by short-acting mydriatica, which do not increase intraocular pressure with prolonged use and do not give side effects (dry mouth, psychotic reactions in the elderly). In order to exclude the side effect of the drug on the patient's body, it is advisable to dip the area of the lower lacrimal point and lacrimal sac with a finger when the atropine is instilled for 1 minute, when the drug does not penetrate through the lacrimal passages into the nasopharynx and gastrointestinal tract.

At the stage of calming the eye, you can use magnetotherapy, a helium-neon laser, electro- and phonophoresis with medicines to more quickly dissolve the remaining exudate and synechia.

Treatment of chronic iridocyclitis

Treatment of chronic iridocyclitis is long. Tactics of specific etiologic therapy and restorative treatment are developed jointly with a therapist or phthisiatrist. Local activities for tuberculosis iridocyclitis are conducted in the same way as in diseases of other etiologies. They are aimed at eliminating the focus of inflammation, resorption of exudate and prevention of infection of the pupil. With complete adhesion and infection of the pupil, first try to break the adhesions using conservative means (mydriatic and physiotherapeutic effects). If this does not work, the spikes are separated surgically. In order to restore the communication between the anterior and posterior chambers of the eye, laser pulsed radiation is used, through which a hole (coloboma) is made in the iris. Laser iridectomy is usually performed in the upper basal area, since this part of the iris is covered by the eyelid and the newly formed opening will not give too much light.