Iridotsiklit (forward uveit) – the combined inflammatory defeat, the mentioning iris of the eye (iris) and a tsiliarny body of an eye. At a sharp iridotsiklit hypostasis, reddening and eye pain, dacryagogue, change of color of an iris, narrowing and deformation of a pupil, formation of a hypopeony, pretsipitat, decrease in visual acuity is observed. Diagnostics of an iridotsiklit includes survey, a palpation, biometrics and ultrasonography of an eye, visual acuity check, measurement of intraocular pressure, carrying out clinical laboratory, immunological researches. Conservative treatment of an iridotsiklit is based on anti-inflammatory, antibacterial and antiviral therapy, purpose of antihistaminic, hormonal, dezintoksikatsionny medicines, midriatik, immunomodulators, vitamins.
Iridotsiklit, Irit, tsiklit, keratouveit treat in ophthalmology so-called forward uveita – inflammations of a vascular cover of an eye. In view of close anatomic and functional interaction of an iris and a tsiliarny (ciliary) body, inflammatory process, having begun in one of these parts of a vascular cover of an eye, very quickly extends to another and proceeds in the form of an iridotsiklit.
Iridotsiklit it is diagnosed for persons of any age, but is more often at patients from 20 to 40 years. On the course of a disease distinguish sharp and chronic iridotsiklit; on the nature of inflammatory changes - serous, ekssudativny, fibrinozno-plastic and hemorrhagic; on an etiology – infectious, infectious and allergic, allergic noninfectious, post-traumatic, not clear etiology, and also caused by system and syndromic diseases. Duration of a sharp iridotsiklit makes 3-6 weeks, chronic – several months; the disease and a recurrence, as a rule, arise in cold season.
Reasons of an iridotsiklit
The reasons, defiant iridotsiklit, are diverse, can have endogenous or exogenous character. Often iridotsiklit develops owing to traumatic injury of an eye (wound, a contusion, ophthalmologic operations), inflammations of an iris (keratit). Iridotsiklit can cause the postponed viral, bacterial or protozoan diseases (flu, measles, VPG, a staphylococcal and streptococcal infection, tuberculosis, gonorrhea, clamidiosis, toxoplasmosis, malaria, etc.), and also the available centers of a chronic infection in a nasopharynx and a mouth (sinusitis, tonsillitis).
Rheumatoid states can be the cause of an iridotsiklit (rheumatism, Steel's disease, autoimmune tireoidit, Bekhterev's disease, syndromes of Reuters and Shegren), exchange violations (gout, diabetes), system diseases of an unknown etiology (, Bekhchet's disease, a syndrome of Fogta-Koyanagi-Harady). Prevalence of an iridotsiklit among patients with rheumatic and infectious diseases makes about 40% of cases.
Emergence of an iridotsiklit is promoted by the developed vascular network of an eye and the raised susceptibility of an iris and ciliary body to the anti-genes and the CEC getting from the extra eye centers of an infection or noninfectious sources of a sensitization.
At development of an iridotsiklit, besides direct defeat of a vascular cover of an eye its immunological damage to participation of mediators of an inflammation happens microbes or their toxins. The inflammation is followed by the phenomena of an immune tsitoliz, vaskulopatiya, disfermentozy, violations of microcirculation with the subsequent scarring and dystrophy.
Important value in development of an iridotsiklit belongs to provocative factors — endocrine and immune frustration, stressful situations, overcooling, excessive physical activity.
Symptoms of an iridotsiklit
Degree of expressiveness and feature of a current of an iridotsiklit depend by nature and duration of influence of an anti-gene, level of permeability of a gematooftalmichesky barrier, a genotype and the immune status of an organism. At an iridotsiklita unilateral damage of eyes is usually observed. The first signs of a sharp iridotsiklit are the general reddening and eye pain, with characteristic considerable strengthening of pain when pressing on an eyeball. Patients with iridotsiklity have a photophobia, dacryagogue, insignificant (within 2-3 lines) decrease in visual acuity, emergence before eyes of "fog".
Noticeable change of color of the inflamed iris of the eye (greenish or rubiginous) and decrease in clearness of its drawing is peculiar to a current of an iridotsiklit. Emergence of moderately expressed corneal syndrome, a perikornealny injection of vessels of an eyeball is possible. In the forward camera of an eye serous, fibrinozny or purulent exudate can be found. At subsidence of purulent exudate at the bottom of the forward camera of an eye the hypopeony in the form of a gray or flavovirent strip is formed; at a rupture of a vessel in the forward camera the blood congestion — a gifema comes to light.
Inflammatory process in a ciliary body at subsidence of exudate on a surface of a crystalline lens and fibers of a vitreous body can lead them to turbidity and to decrease in visual acuity.
On a back surface of a cornea at an iridotsiklita there are grayish-white pretsipitata from pointed deposits of cages and exudate at which rassasyvaniye pigmentary glybk are long noted. Hypostasis of tissues of iris and its close contact with the forward capsule of a crystalline lens in the presence of exudate leads to formation of back solderings (sinekhiya) causing irreversible narrowing () and deformation of a pupil, to deterioration in its reaction to light. At an union of an iris and a forward surface of a crystalline lens throughout circular soldering is formed. At an adverse current of an iridotsiklit of a sinekhiya create risk of development of a blindness because of a full zarashcheniye of a pupil.
Often intraocular pressure at an iridotsiklita happens below norm due to oppression of secretion of moisture of the forward camera. Sometimes, at sharply beginning iridotsiklit with the expressed ekssudation or an union of pupillary edge of an iris with a crystalline lens, increase in intraocular pressure is observed.
The features of a clinical picture are peculiar to different types of an iridotsiklit. Virus iridotsiklita are characterized by a torpedo current, education serous or serous exudate and light pretsipitat, the increased intraocular pressure.
Tubercular iridotsiklit proceeds with ill-defined symptomatology, is shown by existence of large "grease pretsipitat", yellowish (hillocks) on an iris, an opalestsirovaniye of moisture of the forward camera, formation of powerful back stromalny sinekhiya, we obscure sight or a full zarashcheniye of a pupil.
The heavy recidivous current against the background of exacerbations of the main disease with frequent development of complications is inherent in an autoimmune iridotsiklit (cataracts, secondary glaucoma, a keratit, a sklerit, an eyeball atrophy). Each recurrence proceeds heavier previous and often leads to a blindness.
At a traumatic iridotsiklit the sympathetic inflammation of a healthy eye (a sympathetic oftalmiya) can develop. Iridotsiklit at a syndrome of Reuters, caused by a chlamydial infection, is followed by conjunctivitis, uretrity and damage of joints with insignificant manifestations of an inflammation of a vascular cover.
Diagnostics of an iridotsiklit
The diagnosis of an iridotsiklit is established by results of comprehensive examination: ophthalmologic, laboratory and diagnostic, radiological, consultations of the patient with narrow experts.
Originally the ophthalmologist performs external examination of an eyeball, a palpation, collecting anamnestichesky data. For specification of the diagnosis of an iridotsiklit carry out visual acuity check, measurement of intraocular pressure by method of a contact or contactless tonometriya, the eye biomicroscopy revealing defeat of eye structures, ultrasonography of an eye with the one-dimensional or two-dimensional image of an eyeball. The procedure of an oftalmoskopiya at an iridotsiklita is often complicated because of vospalitelno the changed forward departments of an eye.
For clarification of an etiology of an iridotsiklit appoint the general and biochemical blood tests and urine, a koagulogramma, revmoproba for detection of system diseases, allergoproba (local and general reactions to introduction of allergens of a streptococcus, staphylococcus, specific anti-genes: tuberkulina, toksoplazmina, etc.), PTsR and IFA-diagnostics of the activator of an inflammation (including syphilis, tuberculosis, herpes, clamidiosis etc.).
For assessment of the immune status carry out a research of level of serumal immunoglobulins in blood IgM, IgG, IgA, and also their content in plaintive liquid.
Depending on features of a clinical picture of an iridotsiklit consultation and inspection at the rheumatologist, the phthisiatrician, the stomatologist, the otorhinolaryngologist, the allergist, the dermatovenerologist is necessary. Carrying out a X-ray analysis of lungs and additional bosoms of a nose is possible.
Perform differential diagnostics of an iridotsiklit and other diseases which are followed by hypostasis and reddening of eyes, such as sharp conjunctivitis keratit, a bad attack of primary glaucoma.
Treatment of an iridotsiklit
Treatment of an iridotsiklit has to be timely and whenever possible directed to elimination of the reason of its emergence.
Conservative treatment of an iridotsiklit is focused on prevention of formation of back sinekhiya, decrease in risk of development of complications and includes measures of emergency aid and planned therapy. During the first hours diseases the instillation in an eye of the means expanding a pupil (midriatik), NPVS, corticosteroids, reception of antihistaminic medicines is shown.
Planned treatment of an iridotsiklit is carried out in the conditions of a hospital, its basis is made by local and general antiseptic, antibacterial or antiviral therapy, introduction of anti-inflammatory nonsteroid and hormonal medicines (in the form of eye drops, parabulbarny, subkonyyunktivalny, intramuscular or intravenous injections. Corticosteroids are widely used in treatment of an iridotsiklit of toksiko-allergic and autoimmune genesis.
At an iridotsiklita dezintoksikatsionny therapy (is carried out at the expressed inflammation - a plasma exchange, haemo sorption), instillations of solutions of the midriatik preventing an iris union with a crystalline lens. Appoint antihistamines, polyvitamins, immunostimulators or immunosupressor (depending on the main disease), local and proteolytic enzymes for a rassasyvaniye of exudate, pretsipitat and solderings. Often at an iridotsiklita physiotherapeutic procedures are applied: electrophoresis, magnetotherapy, laser therapy.
Iridotsiklit a tubercular, syphilitic, toksoplazmozny, rheumatic etiology demands performing specific therapy under control of the corresponding experts.
Surgical treatment of an iridotsiklit is carried out in need of division of solderings or (a section of forward and back sinekhiya of an iris), in case of development of secondary glaucoma. In case of a heavy complication of a purulent iridotsiklit with lysis of covers and contents of an eye surgical removal of the last (an enukleation, an eye evistseration) is shown.
Forecast and prevention of an iridotsiklit
The forecast of an iridotsiklit at the timely, adequate and carefully carried out treatment – quite favorable. The absolute recovery after treatment of a sharp iridotsiklit is noted approximately in 15 — 20% of cases, in 45 — 50% of cases - the disease accepts a subsharp recidivous current with more erased recurrence which often coincides with exacerbations of the main disease (rheumatism, gout).
Iridotsiklit can pass into a chronic form with persistent decrease in sight. In the started and uncured cases of an iridotsiklit the dangerous complications menacing to sight and existence of an eye develop: horioretinit, the union and a zarashcheniye of a pupil, secondary glaucoma, a cataract, deformation of a vitreous body and an otsloyka of a retina, abscess of a vitreous body, endoftalmit and panoftalmit, a subatrophy and an atrophy of an eyeball.
Prevention of an iridotsiklit consists in timely treatment of the main disease, sanitation of the centers of a chronic infection in an organism.