Irit – an inflammation of an iris of the eye of an eyeball. The clinical symptomatology is presented by sight "zatumanivaniye", morbidity in an eye-socket, hyperaemia, hypostasis and change of the drawing of an iris of the eye. Diagnostics includes a vizometriya, a gonioskopiya, perimetry, biomicroscopy, ultrasonography of an eye, a tonometriya, studying of cellular composition of intraocular liquid and reaction of pupils to light. Conservative treatment comes down to purpose of antibacterial means, nonsteroid anti-inflammatory medicines, glucocorticoids, midriatik. The physical therapy and vitamins of group C, A and P is in addition applied.
Irit – widespread pathology in practical ophthalmology. Often it is considered in the context of a forward uveit or an iridotsiklit. Epidemiological characteristics directly are defined by etiologichesky option of a disease. Against the background of system defeats (Bekhterev's disease, Reuters) Irit develops in 10% of cases. In 30-60% the oftalmopatologiya gets a chronic current. The disease is diagnosed at any age, but most often revealed at patients of 20-40 years. The iris inflammation with an identical frequency occurs among men and women. Geographical features of distribution are not noted.
The inflammation of an iris can develop separately or to be one of displays of some system diseases. Secondary Irit often arises against the background of Bekhterev's disease, Reuters, psoriasis, Fuchs's syndrome, glaukomotsiklitichesky crisis. The main reasons for primary form are presented:
- Injuries of forward department of eyes. An inflammation of a uvealny path – widespread reaction of tissues of eye to traumatic damage, a burn or penetration of a foreign matter.
- Infectious diseases. Ability to provoke Irit's development is noted at causative agents of tuberculosis, toxoplasmosis, syphilis, leptospirosis and brucellosis. The role of a b-hemolytic streptococcus of group A and a gonokokkovy infection in an iris inflammation is studied.
- Metabolic frustration. Development of pathology exponentiates a hormonal imbalance at patients with diabetes, a hypothyroidism, a gipokortitsizm in the anamnesis.
- Allergic reactions. The iris inflammation symptomatology often appears against the background of individual intolerance of medicines for installation or retrobulbarny introduction, system allergic reactions.
- Yatrogenny influence. The disease quite often arises after carrying out surgical interventions on an iris of the eye (a laser iridektomiya, plasticity of an iris).
The important part in the mechanism of development of Irit is assigned to anti-genes of the main complex of a gistosovmestimost of HLA-B27. The interrelation between developing of a disease and influence of endotoxin of gramotritsatelny bacteria is proved. The essential contribution to an inflammation of an iris of the infectious nature is made by autoimmune reactions which are based on a phenomenon of a molecular mimicry. At the same time the infectious agent has anti-gene determinants, similar to cellular elements of the patient. Defeat of a cover of an eye and penetration of pathogens through a gematooftalmichesky barrier is caused by the cross immune answer.
At virus genesis of Irit anti-genes of HLA-B27 form complexes which are distinguished by T-cages as alien with the anti-gene device of a virus. It leads to their destruction. Activation of local immunity leads to development of inflammatory changes of an iris of the eye. In response to synthesis of pro-inflammatory tsitokin (a histamine, , A2, interleykina 1, 2, 6, 8) permeability of vessels increases. It involves an exit of plasma and a small amount of uniform elements in interstitsialny fabric that is shown by hypostasis and hyperaemia. The congestion of lymphocytes in the thickness of an iris causes formation of small knots to Keppa near sosochkovy edge and Busakk's small knots on a forward boundary leaf of an iris.
Gradual increase of clinical manifestations is characteristic of Irit. Beginning of a disease often asymptomatic. Patients connect strengthening of symptomatology with overcooling, stressful factors, contact with infectious patients or an exacerbation of background pathology. The first symptoms of a disease – the raised dacryagogue, feeling of discomfort in an orbital zone. When progressing hyperaemia of eyes, hypostasis of an iris of the eye is noted that is shown by decrease in clearness of its drawing. The pain syndrome amplifies when pressing an eyeball.
Frequent the first symptom with which patients ask for the help the expert is existence of sites of hemorrhage or change of color of an iris. As a rule, coloring of a cover becomes lighter, the contour smoothes out a little. Narrowing of a pupil and the slowed-down reaction to light is noted. Because of violation of the refracting force of an eye visual acuity decreases. Patients show complaints to emergence of "fog" before eyes. At long visual loadings astenopichesky symptoms develop: burning of eyes, a headache with irradiation in nadbrovny arches, the general weakness.
Formation of solderings between pupillary edge and a forward surface of a crystalline lens (back sinekhiya), an iris and a cornea (forward sinekhiya) is characteristic of Irit. The heaviest complication of this pathology – secondary glaucoma which development is provoked by a congestion and the organization of exudate in the field of trabekulyarny network of an eye. At a recidivous current of Irit there is a high risk of development of a cataract. Because of the increased permeability of a vascular wall the disease can be complicated by subconjunctival hemorrhage, gemoftalmy or gifemy. Identification of purulent contents in the camera demonstrates emergence of a hypopeony.
For diagnosis fizikalny examination is conducted, the special complex of tool and laboratory methods of a research is appointed. At visual survey the perikornealny injection, an illegibility of the drawing of an iris is defined. The plan of inspection includes the following methods:
- Gonioskopiya. The technique allows to reveal muddy liquid (often – purulent character) in the forward camera, morphological changes of drainage system of an eye.
- Research of cellular reaction. For the purpose of establishment of activity of an inflammation study cellular reaction of moisture of the forward camera. At 1 degree the accurate drawing of an iris is defined, at 2 Art. separate structures give in to differentiation, at 3 Art. survey is sharply complicated, at 4 Art. the iris of the eye is not visualized.
- Eye biomicroscopy. The method gives the chance to find such objective signs of Irit as puffiness, existence of the granulematozny centers of defeat, dystrophic changes of an iris of the eye, back sinekhiya.
- Definition of reaction of a pupil to light. Absence or sharp decrease in reaction to light comes to light. After conducting test from midriatika the photosensitivity raises.
- Vizometriya. The decrease in visual acuity caused by changes in a svetoprelomleniye in total with a spasm of the akkomodatsionny device is observed.
- Perimetry. Concentric narrowing of the visual field is noted.
- Ultrasonography of an eye. Ultrasonography is applied to identification of morphological changes which stimulate development of pathology, and also for visualization of secondary damages of an organ of vision (existence of forward and back sinekhiya, a cataract).
- Tonometriya. Irit is followed eye hypo - or hypertensia. At increase in an oftalmotonus for the purpose of studying of intraocular hydrodynamics carry out an eye tonografiya.
From laboratory methods definition of antibodies to anti-genes of activators by the IFA method, HLA typing, the test for identification of the circulating immune complexes, a rheumatoid factor and population of T-lymphocytes is shown. The purpose of application of these methods of diagnostics – to establish a disease etiology. If necessary the test of a patergiya, the forward camera and a vitrealny biopsy is in addition used.
Etiotropny treatment is based on elimination of background pathology. Identification even of ill-defined symptomatology from an organ of vision at infectious and system diseases demands consultation of the ophthalmologist. Conservative therapy of Irit includes application of the following means:
- Antibacterial medicines. Are appointed at bacterial genesis of an inflammation. Before carrying out a course of antibiotic treatment it is necessary to define sensitivity of activators to medicines.
- Antiviral means. Are shown at the established virus origin of pathology. For achievement of effect therapy is used system and local (instillations, parabulbarny injections).
- Nonsteroid resolvents (NPVS). The application purpose – to stop an active inflammation. At low efficiency or generalization of process purpose of glucocorticoids is shown.
- Midriatiki. The medicines expanding a pupil are used for prevention of formation of forward sinekhiya. Midriatiki are appointed only with the normal or lowered intraocular pressure.
- Vitamin therapy. Throughout the entire period of treatment apply vitamins of group A, C and P.
- Physical therapy. At identification of back solderings by means of an electrophoresis enter , midriatik and papainase. After knocking over of sharp inflammatory process appoint an electrophoresis with extracts of an aloe and lidazy.
Forecast and prevention
The forecast for life and working capacity favorable. Specific prevention of Irit is not developed. Nonspecific preventive measures are based on timely diagnostics of damage of an eyeball at system and infectious pathologies. The persons working at a factory need to use individual protection equipment (points, helmets). To the patients suffering from metabolic frustration (a hypothyroidism, diabetes, a gipokortitsizm) or within the last two years transferred surgeries on an iris, with the preventive purpose it is necessary to undergo 2 times a year inspection at the ophthalmologist.