ACUTE IRIDOCYCLITIS
SUNIL PAI B
ROLL NO:78
IRIDOCYCLITIS
• It is the inflammation of Iris and anterior part
of ciliary body(Pars Plica)
SYMPTOMS
1. Pain
2. Redness
3. Photophobia and Blepharospam
4. Lacrimation
5. Defective vision
SIGNS
I. LID EDEMA
II. CIRCUMCORNEAL CONGESTION
III. CORNEAL SIGNS
1. Corneal edema
2.Keratin precipitates
– They are cellular deposits on the corneal
endothelium.
– Their characteristics and distribution indicate the
type of uveitis.
1.Large KP(Mutton fat KP)
– It is composed of macrophages and epitheloid cells.
– It is greasy in appearance.
– It is usually 15 in number.
– It occurs in granulomatous uveitis
2.Medium and small KP(Endothelial dusting)
– It is composed of lymphocytes.
– It is dirty white.
– It is usually 100 in number.
– It occurs in non granulomatous uveitis.
3. Red KP
– It is composed of inflammatory cells and RBC.
– It is seen hemorrhagic uveitis.
4. Old KP
– All above KP heal and become small pigmented irregular
in shape.
ANTERIOR CHAMBER SIGNS
1. Aqueous cells
The cells should be counted in an oblique
slitlamp beam, 3-mm long and 1-mm wide,
with maximal light intensity and
magnification, and graded as :
– = 0 cells,
± = 1–5 cells,
+1 = 6–10 cells,
+2 = 11-20 cells,
+3 = 21–50 cells
+4 = over 50 cells
2.Aqueous flare
It is due to scattering of light by proteins that
have leaked into aqueous humor through the
damaged iris blood vessels,and graded as
0 = No flare
+1 = Faint flare
+2 = Moderate flare
+3 = Marked flare
+4 = Intense flare
3. Hypopyon (sterile pus in the anterior chamber)
When exudates are heavy and thick,they settle
down in lower part of the anterior chamber as
hypopyon.
4. Hyphaema (Blood in the anterior chamber)
It may be seen in haemorrhagic type of
uveitis.And ansome eyes with chronic
iridocyclitis.
5. Changes in depth and shape of anterior chamber
may occur due to synechiae formation.
6. Changes in the angle of anterior chamber.
V. IRIS CHANGES:
1. Loss of normal pattern
It occurs due to oedema and waterlogging of iris in active
phase and due to atrophic changes in chronic phase.
2. Changes in iris colour
Iris usually becomes muddy in colour during active phase and
may show hyperpigmented and depigmented areas in healed
stage.
3. Iris nodules
These occur typically in
1. Koeppe’s nodules are situated at the pupillary border and
may initiate posterior synechia.
2. Busacca’s nodules situated away from pupillary border are
large but less common than the Koeppe’s nodules.
4. Posterior synechiae
- These are adhesions between the posterior surface of iris and anterior
capsule of crystalline lens
- These are formed due to organisation of the fibrin-rich exudates.
1. Segmental posterior synechiae
It refers to adhesions of iris to the lens at some points
2. Annular posterior synechiae
- It refers to 360 adhesions of pupillary margin to anterior capsule of lens
- These prevent the circulation of aqueous humour from posterior
chamber to anterior chamber (SECLUSIO PUPILLAE)
-Thus, the aqueous collects behind the iris and pushes it anteriorly (leading
to IRIS BOMBE formation)
3. Total posterior synechiae
It refers to complete plastering of total posterior surface of iris with the
anterior capsule of lens
VI. PUPLLARY SIGNS
1. Narrow pupil.
It occurs due to irritation of sphincter pupillae by toxins.
2. Irregular pupil shape.
It results from segmental posterior synechiae formation.
3. Ectropion pupillae (Evertion of pupillary margin).
It may develop due to contraction of fibrinous exudate on
the anterior surface of the iris.
4. Occlusio pupillae (Pupil is completely occluded )
It occurs due to organisation of the exudates across the
entire pupillary area.
5. Pupillary reaction becomes sluggish or may even be
absent.
VII. LENS SIGNS
1. Pigment dispersal on the anterior capsule of
lens is almost of universal occurrence in a case
of anterior uveitis.
2. Exudates may be deposited on the lens in
cases with acute plastic iridocyclitis.
3. Complicated cataract may develop as a
complication of persistent iridocyclitis.
TREATMENT
I. NON SPECIFIC TREATMENT
(a) LOCAL TREATMENT
1. MYDRIATIC
1% Atropine, instilled 2-3 times a day
In case of atropine allergy,
2% Homatropine or 1% Cyclopentolate,
instilled 3-4 times day
2. CORTICOSTEROIDS
Dexamethasone instilled 4-6 times a day
(b) SYSTEMIC THERAPHY
1. CORTICOSTEROIDS
It is indicated when topical theraphy fails.
Aspirin 60-100mg for 2 weeks.
2. NSAID’s
- It is indicated when steroids are contraindicated.
- Phenylbutazone and oxyphenbutazone
3.IMMUNOSUPPRESIVE THERAPHY
- It also indicated when steroid theraphy fails and there is a
imminent danger of blindness.
- cyclophosphamide, chlorambucil, azathioprine and
methotrexate can be used
(c) PHYSICAL MEASURES
1. Hot fomentation
It is very soothing, diminishes pain and
increases circulation, and thus reduces the venous
stasis. As a result more antibodies are brought and
toxins are drained. Hot fomentation can be done
by dry heat or wet heat.
2. Dark goggles.
These give a feeling of comfort, especially when
used in sunlight, by reducing photophobia,
lacrimation and blepharospasm.
II. SPECIFIC TREATMENT
The non-specific treatment described above is
very effective and usually eats away the uveal
inflammation in most of the cases, but it does
not cure the disease, resulting in relapses.
Therefore, all possible efforts should be made
to find out and treat the underlying cause
THANK
YOU
