Iridocyclitis can be considered anterior uveitis as the inflammation reaches the anterior part of the uvea. It is very common, often affects both eyes and often tends to recur. Iridocyclitis is distinguished from posterior uveitis, which affects the choroid, and panuveitis, which is the concomitant inflammation of the three parts of the uvea, namely: the iris, the ciliary body and the choroid. Most iridocyclitis are acute and 25% are chronic. It is possible to notice, during inflammations, adhesions of the anterior surface of the lens and the posterior layer of the iris.
Liris is the colored part of the eye, it is a circular membrane, bathed in aqueous humor which serves as the vertical diaphragm of the eye and separates the anterior chamber and the posterior chamber which goes to the lens. At its center is the orifice of the pupil which, through its constrictor miosis and dilator mydriasis muscles, controls the amount of light entering the eye through the closing and opening of the pupil. The ciliary body, located between the root of the iris and the choroid, has a role in the accommodation of the ciliary muscle and the secretion of aqueous humor.
- Chronic iridocyclitis: inflammation that lasts for several months or years. Its onset is usually insidious and may be asymptomatic. However, acute episodes are still possible.
- Acute iridocyclitis: onset suddenly, it usually persists for less than six weeks. If the inflammation reappears after the initial episode, it is called acute relapsing uveitis.
3. Causes etiology
The multiple causes of iridocyclitis are usually difficult to determine:
When iridocyclitis has no obvious etiology and does not enter into a known syndrome, then either a follicular tuberculosis or focal infection is considered.
Either of immunological origin: these iridocyclitis can occur following a bacterial infection, viral herpes, shingles especially or parasitic leptospirosis.
Often, iridocyclitis does not have an obvious etiology but falls into a known syndrome, such as Fuchs, which is the most common, or Heerfordt syndrome.
Either symptoms of a rheumatic disease or of a so-called systemic disease, including autoimmune diseases.
4. Symptoms and diagnosis
Symptoms of inflammation vary. This can range from a dull ache in the eye or forehead to visual disturbances or marked decrease in acuity, or even tearing and photophobia fear of light. In chronic iridocyclitis, symptoms may be minimal. On examination, the eye is red but the injection is limited to the periphery of the cornea ciliary injection. A complete ophthalmologic examination is necessary if any of these symptoms appear, as it is important to treat the inflammation promptly due to the decrease in vision. The ophthalmologist examines the slit lamp. He may discover proteins and inflammatory cells in the aqueous humor Tyndall effect and sometimes hypopyon, a lower whitish level which corresponds to aseptic pus by lower sedimentation in case of very strong Tyndall effect.
There are two different types of treatment: symptomatic treatment and etiological treatment. The first treatment, symptomatic, is the most frequent. This treatment consists of two principles, to prevent the iris from sticking to the cornea or the lens and to fight against inflammation. Mydriatics or systemic corticosteroid therapy are usually used. The purpose of mydriatics is to dilate the pupil and thus prevent its adhesion to the lens. These adhesions are called synechiae and frequently result in the deformation of the clover pupil. Atropine 1% is used twice a day, which may be combined with neosynephrine 10%. If synechiae are already formed and do not yield to this treatment, it is necessary to add a subconjunctival injection of adrenaline to it and this until the end of the inflammatory phenomena. During corticosteroid therapy, or the use of corticosteroids, the patient may receive retro orbital cortisone injections behind the orbit. However, there are sometimes phenomena of therapeutic rebound. Antibiotics are used when there is an infection. They are used in the form of eye drops or intraocular injections inside the eye. The second etiologic treatment will be prescribed whenever a specific cause relates to a defined therapy.
Many iridocyclitis heal without sequelae, as is the case with most iridocyclitis of viral origin that is properly diagnosed and treated correctly. However, others recur if the etiology is not determined or is incurable. The repetition of the outbreaks can sometimes lead to complications, such as the constitution of iridocrystallian synechiae, goniosynechiae, cataracts, etc.