Iridocyclitis
Iridocyclitis is an ophthalmology term that means that certain internal structures of the eye are inflamed. Iridocyclitis is a part of uveitis, another medical term describing the inflammation of the inner portion around the iris but behind cornea.
In this article:
- What is iridocyclitis?
- Types of iridocyclitis
- What are the causes of iridocyclitis?
- What are the symptoms of iridocyclitis?
- Iridocyclitis Incidence
- How is iridocyclitis diagnosed?
- How Long Does the Condition Last?
- Preventing Iridocyclitis
- Understanding Iridocyclitis
- References
What is iridocyclitis?
Iridocyclitis is an ophthalmology term that means that certain internal structures of the eye are inflamed. Iridocyclitis is a part of uveitis, another medical term describing the inflammation of the inner portion around the iris but behind cornea. The Standardization of Uveitis Nomenclature (SUN) consensus conference workshop classified uveitis into:
- Anterior (iritis, iridocyclitis, anterior cyclitis),
- Intermediate (pars planitis, posterior cyclitis, hyalitis),
- Posterior uveitis (choroiditis, chorioretinitis, retinochoroiditis, retinitis, and neuroretinitis),
- Panuveitis based on the anatomical location.
This is nomenclature used by eye doctors to determine which structures of the eye uveal tract (iris, ciliary body, and choroid) got involved in inflammation. This can be happening separately, or together with external parts of the eye and deeper layers: like the retina, retinal vessels, vitreous, optic nerve head, cornea and sclera.
Types of iridocyclitis
The most common type is idiopathic – when the reason cannot be found. One of them is Fuchs uveitis syndrome (FUS).
Other types are less common:
- Traumatic iridocyclitis
- Inflammatory iridocyclitis
- Infectious iridocyclitis
What are the causes of iridocyclitis?
As it is mentioned above, types of iridocyclitis identified by what is causing it. Systemic inflammatory disorders commonly associated with iridocyclitis include:
- Rheumatic diseases, such as HLA-B27-associated entities, juvenile idiopathic arthritis, inflammatory bowel disease,
- Autoimmune diseases: sarcoidosis, Behcet’s disease (BD) or tubulo-interstitial nephritis (TINU), multiple sclerosis, Vogt-Koyanagi-Harada syndrome, lupus
- Malignancies (leukemia)
Iridocyclitis can be caused by infections:
- Viruses (HSV, VZV, CMV),
- Bacteria (endophthalmitis, syphilis, tuberculosis, etc)
- Parasites/worms (toxoplasmosis, Lyme Disease, toxocara, Bartonella sp)
What are the symptoms of iridocyclitis?
Symptoms will vary significantly, depending on the type of iridocyclitis. The process may affect one eye or both eyes.
Iridocyclitis common symptoms include:
- Painful eye
- Red eye
- Blurred vision or decreased vision
- Photophobia
- Systemic signs when infection is involved (fever, malaise, cough etc.)
- Affected pupil maybe constricted or irregular in shape when compared to the unaffected eye due to posterior synechia (iris adhesions to the anterior lens capsule).
Ophthalmological symptoms:
- Anterior chamber cell and flare,
- Posterior synechiae,
- Keratic precipitates
- Hypopyon
Iridocyclitis Incidence
Iridocyclitis, as a part of uveitis, can affect people of all ages and can vary significantly by geographic location and age of the patient. In a study done from 2006 to 2007, the incidence of uveitis (including iridocyclitis) was 24.9 cases per 100,000 persons. Prevalence rates for 2006 and 2007 came in at 57.5 and 58 respectively per 100,000 persons.
There was no difference in the incidence rate between men and women, but women had a higher prevalence. Anterior uveitis (iridocyclitis included) accounting for approximately 50% of uveitis cases.
Ongoing inflammation seen in untreated uveitis and complications related to this uncontrolled inflammation are estimated to be responsible for approximately 10% of the blindness in the United States.
Idiopathic cases of uveitis account for 48 to 70% of uveitis cases. Infectious processes are thought to account for approximately 20% of all uveitis cases but underlying causes can vary geographically
How is iridocyclitis diagnosed?
A complete past medical, family, and ophthalmic history (specifically surgical) is necessary for diagnosis. A full review of systems may also help identify a systemic disease with eye involvement.
Diagnosis is made by an ophthalmologist who will use couple of common techniques:
- Vision test (visual acuity testing)
- Slit lamp microscopy (after dilating your eyes)
- Measurement of intraocular pressure (iop)
On slit lamp exam, local or diffuse ciliary flush may be seen. One would also expect to see cell and flare in the anterior chamber. “Cell” refers to a collection of white blood cells in the anterior chamber; the cells may be so dense that it has settled to form a white, dependent, hypopyon (layered white blood cells within the anterior chamber).
Other ocular pathology such as posterior synechiae, cataract formation, rubeosis (blood vessels on the iris surface), and band keratopathy may suggest a longstanding inflammatory process or prior event if found in the unaffected eye.
These findings can help aide in clarifying the differential diagnosis as a unilateral anterior uveitis versus a non-simulutaneous, bilateral anterior uveitis as they can have a different differential diagnosis.
How Long Does the Condition Last?
There is no prediction how long iridocyclitis will last. The goal of the treatment is to immediately address an infection and inflammation to prevent scarring and deposits in a vision-sensitive areas.
Iridocyclitis that is due to autoimmune conditions might require life-long systemic treatments, while symptoms will be completely controlled.
Preventing Iridocyclitis
The eye inflammation is always a dangerous condition, as it may lead to irreversible damage of the layers of the optic system causing blindness. If any of the infections that is known to cause eye iridocyclitis suspected or diagnosed, a person should immediately schedule a visit to an ophthalmologist for a full eye exam.
It is crucially important to keep follow-up appointments after any eye surgery to prevent possible infection. Also, you must follow the medication regimen, which includes an antibiotic eyedrops. While it is tedious to administer the eyedrops, try not to miss times, even if you need to do so every 4 hours.
Any autoimmune and rheumatic disease can potentially affect the eye, sometimes not showing any symptoms for a while. An eye exam should be done yearly, unless inflammation is diagnosed – then the eye doctor will tell you how often you should come for a follow-up.
Understanding Iridocyclitis
Except for the cases caused by the infections and surgical intervention, we do not know much about why iridocyclitis develop. For example, Fuchs uveitis syndrome (FUS) is a chronic, typically unilateral mild anterior uveitis that was first described by Ernst Fuchs in 1906.
FUS is also referred to as Fuchs heterochromic uveitis and Fuchs heterochromic iridocyclitis. When first described, Fuchs had many theories about what caused this unique pathology; however, over the years, many of these have been largely disproven, with the infectious theory remaining as one of the more probable causes.
Different color of the eyes that is not familial (non-hereditary heterochromia) is present in about 13.9% of patients with FUS. Usually, a patient with lighter eye colors will notice a lightening in the affected eye. Patients with a darker colored iris have more pigment cells in the anterior border layer of the iris, making the difference in the iris less apparent.
The patient population demographics in iridocyclitis vary by geographic locations, with different rates of incidence, age of symptom presentation, and rates of complications depending on the subpopulation studied.
Most patients with iridocyclitis experience changes in vision mainly due to secondary complications, such as cataract and glaucoma. Treatment of these complications leads to a good prognosis.
References
Uveitis. Duplechain A, Conrady CD, Patel BC, Baker S.2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 31082037 Free Books & Documents. Review.
Chorioretinitis. Geetha R, Tripathy K.2021 Aug 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. PMID: 31869169 Free Books & Documents. Review.
Fuchs Uveitis Syndrome. Moshirfar M, Villarreal A, Ronquillo Y.2021 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 32644574 Free Books & Documents. Review.
Syphilis Ocular Manifestations. Koundanya VV, Tripathy K.2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 32644383 Free Books & Documents. Review.
HLA B27 Syndromes. Parameswaran P, Lucke M.2021 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 31855367 Free Books & Documents. Review.
Nonspecific Orbital Inflammation. Ronquillo Y, Patel BC.2021 Jul 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 31869057 Free Books & Documents. Review.