Iridocyclitis

Iridocyclitis is an eye disease that causes inflammation in the Uvea and its associated parts, namely:

  • Iris: Colored part of the eye
  • Ciliary body:  Cluster of arranged muscles and tissues that help the eye to focus.

Iridocyclitis is a common term used for ‘uveitis’ or ‘iritis.’

Types

Based on the ocular conditions and effects of the disease, there are six types:

  • Chronic Iridocyclitis: Persists for more than six weeks and usually, they don’t show any genuine symptoms. Some disorders such as syphilis, ankylosing spondylitis, inflammatory bowel disease and Reiter’s syndrome are associated with Chronic Iridocyclitis.
  • Acute Iridocyclitis: Occurs suddenly and persists for around six weeks.
  • Exogenous Iridocyclitis: Happens due to external injury and microbial infection in the uvea.
  • Endogenous Iridocyclitis: Arises due to internal microbial infection.
  • Granulomatous Iridocyclitis: Cellular deposits also called keratic precipitate or deposit present on corneal endothelium are large and appear greasy-white. Macrophages and endothelial cells produce these deposits.
  • Non-granulomatous Iridocyclitis: Usually correlates with small cellular deposits.

How long does it remain?

It depends on the type because each has a different recovery period. The serious types may persist for several months to a year. The common ones such as non-granulomatous Iridocyclitis usually last for a few weeks.

Iridocyclitis V/s Uveitis

Iridocyclitis is denoted as a type and character of Uveitis. On the other hand, ‘Uveitis’ is an umbrella term for soreness and inflammation of the entire Uvea. The disease mostly occurs because of bacterial infection, but sterile inflammation causes uveitis which is categorized and named according to the affected parts of the eye.

Iridocyclitis V/s Iritis

Iritis is called anterior uveitis as it affects the frontal part of uvea while Iridocyclitis is intermediate uveitis.

Causes

The Uvea performs the function of transporting gases and nutritional elements required by the eyes. Iris and ciliary body is a part of the uvea. They produce fluid and control the movement of the eye. Some major causes are:

  • Exposure to chemicals such as lachrymators (tear gas)
  • Tissue damage
  • Toxic substance
  • Germs
  • Infection (Herpes zoster or herpetic Iridocyclitis)
  • Blunt trauma to the eyes
  • Sarcoidosis
  • Tuberculosis
  • Leprosy
  • Toxoplasmosis
  • Herpes simplex and herpes zoster viruses
  • Rheumatoid arthritis

Symptoms

  • Pain in the eye
  • Redness
  • Blurred vision coupled with visual floaters
  • Headache
  • Irregular pupil shape
  • Synechia (sticking of the Iris to the lens or the cornea)
  • The appearance of dark spots in the visual field
  • Black sclera
  • Photophobia (sensitive to light)
  • Eye pain when exposed to bright light
  • Burning sensation in the eyes
  • Excessive and frequent production of tears
  • Contraction of pupil
  • Constricted Pupil
  • Excess sensitivity due to exposure to bright light
  • Iris keeps on sticking to the cornea or the lens

Diagnosis

Slit lamp examination generally detects iridocyclitis, but for an in-depth evaluation the following diagnostic tests may be recommended:

  • Dilated-pupil Fundus Examination (DFE): The doctor uses mydriatic (an agent to dilate pupil) eye drops like tropicamide to dilate the pupil. It is done for obtaining a larger view of the fundus in the eye and the entire process is known as “mydriasis.” With the help of ophthalmoscopy, the doctor examines the interior parts of the eye like retina, blood vessels, optic nerve, iris and other areas.
  • Syphilis testing: Identification of Syphilis is very important as it is also a risk factor.
  • Major histocompatibility antigen testing (MHC test): The test identifies the genetic susceptibility of having iridocyclitis. In this method antigens such as HLA- B27, HLA-A29, and HLA- B51 help to evaluate uveitis.
  • Differential diagnosis: Doctors perform CT scan, X-Ray, laboratory culture, sarcoid testing, viral testing, idiopathic and diagnosis of some other risk factors.
  • Ocular pressure: With the help of equipment like tonometer, the doctor measures the pressure inside the eye to determine the symptoms.

Treatment

Usage of steroidal or topical corticosteroid drops such as prednisone acetate is a potent treatment to control underlying inflammation. On the other hand, use of pupil-dilating drops such as cyclopentolate reduces the pain. It also prevents the complication of the pupil sticking to the adjacent lens. Some other treatments are:

  • Injection: In severe cases, injection (shot) of corticosteroid near the eye or subconjunctival steroid injection is very helpful.
  • Mydriatic eye drops: Eye drops such as phenylephrine and cyclopentolate are compelling treatment.
  • Oral therapy: Recommended consumption of prednisone, atropine and other medicines are also effective.

There is no appropriate and approved surgical treatment yet.

Complications

There are few complications like “synechiae,” the adhesion of iris with eye lens. It can give rise to intraocular pressure which may lead to glaucoma. This disease can cause accumulation of fluid in macula region, which is responsible for the central vision. This complexity is Cystoid macular edema (CME). Fuchs heterochromic Iridocyclitis is often confused with Iridocyclitis due to identical features and some minute differences.

Prognosis

Follow early and regular check-ups by an ophthalmologist as some forms can reoccur.

Reference

  1. http://eyewiki.aao.org/Acute_Anterior_Uveitis
  2. https://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x8650.html
  3. https://nei.nih.gov/health/uveitis/uveitis
  4. http://www.ilpi.com/msds/ref/iridocyclitis.html

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