Radiculitis 

Bombing iris eye: causes, symptoms, treatment. Clinical picture of different types of iridocyclite

The bombing is the pathological position of the iris, protruding in the direction of the front chamber of the eye, which arises as the consequence of diseases and anatomical predisposition.

Main reasons

Waigle.ru presents the main causes of pathology development:

Iridocyclit

Inflammation of the iridescent or ciliary body (iridocyclite) increases the risk of a fusion or to completely infect the edge of the pupil with a crystal. As a result of pathological changes, the pressure is increased inside the eye and the formation of the pupil unit. Specialists of the site "Obaglaza.ru" emphasize your attention that this violation of physiology can occur both on the fakic (with a lens), and on an aifaic (in the absence of a lens) eyes.

Sinechia

The front peripheral battle of the anterior iris with a trabecular network or a cornea of \u200b\u200bthe eye prevents the outflow of intraocular fluid or completely blocks it. Such processes may occur as a result of uveit or anatomical predisposition, with a narrow angle of the front eye chamber.

The rear - manifests itself during the sink of the rear rainbow shell with a crystal or a glassy body. Obaglaza.ru, clarifies that the rainbow shell can form synechia and with the present, and artificial lens. The development of physiological pathologies after underwent uveits depends on the severity, duration and scale of inflammation.

Pupil block

The process in which the liquid duct is difficult or blocked between the chambers of the eye through the pupil. When the spikes are formed on the pupil parts or its membrane, the unit is called partial if the entire pupil is a full block. In the term, the full pupil block "whalesa.pu" refers the process of the combat of the entire pupil around the perimeter and complete cessation of fluid circulation.

As a result, the pressure inside the cameras increases, which leads to a strong bending of the iris to the front chamber or the bombing of the iris.

Occasionally, with uveitis that proceed with the pupil unit, the sprouting of the iris with a crust of large sizes is formed, then the iris becomes fuses only along the periphery. Diagnosis In this case is possible, only with the help of a gonoscope.

Methods for diagnosing buse iris eye

Basic methods for diagnosing bombing of iris from workers.

  1. Inspection by an ophthalmologist;
  2. Consultation therapist (in the presence of chronic diseases).
  3. Visometry - determination of visual acuity;
  4. Biomicroscopy is a thorough inspection of all the structures of the eye with a slit lamp;
  5. Tonometry - measurement of intraocular pressure.

Mandatory condition, establishing the correct diagnosis and determining the cause of the disease there are a number of clinical analyzes:

  • common blood test (main indicators - hemoglobin, platelets, leukocytes) and urine;
  • glucometry (determination of sugar levels);
  • study on syphilis (serological analysis);
  • the presence of antibodies to hepatitis B.

Methods for the treatment of bombing iris

Conservative

If there is a wide range in each pharmacy network medical preparations To reduce and stabilize intraocular pressure, "Oblama.ru" recommends applying:

  • "Dapacarb" in the form of tablets;
  • Mannitol intravenous administration (40% glucose solution with a 10% sodium chloride solution);
  • for efficient local treatment Eye drops - adrenaline with atropine, glucocorticosteroid preparations, thymol.

Surgical

  • iridectomy - the formation of a small hole in the iris, to stabilize intraocular pressure, is carried out with insignificant inflammation. eyeball;
  • iridectomy with a laser can be performed on pseudofaquic eyes (with an artificial lens);
  • sinehiotomy - the dissection of the battle is carried out in the faky eyes.

Choosing a medical institution

For high-quality examination, diagnosis and effective treatment The bombing of the iris "Gaglaz.Ru" advises to select the eye clinic with good specialists who will take care of your health, and not about the difference. It is very important to choose medical institutionwhich will help, and will not specifically delay the recovery process. This not only can bring serious material costs, but also further development inflammatory processes and aggravation of the problem.

If you are diagnosed with the bombing of the iris, "Oglama" recommends that you the following clinics, where you can take a thorough examination and treatment.

The spikes of iris arise in the event that the rainbow sheath is growing with a horn with a cornea (front) or lens (rear). Spikes are formed as a result of eye injury, inflammatory diseases (Iridocyclite, will take away). Sinekhias can lead to the development of intraocular hypertension and glaucoma. With an ophthalmic examination, it is sometimes possible to visualize synefy, but it is better to consider them with the help of a slit lamp and ophthalmoscopes.

The front of the battles can cause the closed-nailed glaucoma, since in this case the iris creates an obstacle to the outflow of water-melting moisture from the anterior chamber. In this case, intraocular hypertension increases. If on the background of the front synech high blood pressure Inside the eyeball, it is necessary to perform cyclodiasis.


At the rear synefishes, glaucoma may also occur, but the mechanism for increasing pressure in this case is different. The iris, fucked with a lens, disrupts the outflow of intraocular moisture from the rear camera to the front. Such a block leads to an increase in the level of intraocular pressure.

With the rear sides of the synefic, there may be separate or to form a continuous tape between the edge of the iris and the lens. In the case of secondary changes, the exudate in the pupil area may have a complete injection of the hole. The pre-crash membrane (circular battle) causes a complete disunity of chambers (front and rear) of the eyeball, resulting in intraocular hypertension. With a sufficient cluster of water-melted moisture in the back of the caper, the iris under the action of pressure begins to empty into the front chamber, that is, the so-called iris bombing occurs. When the annular synefic is formed between the iris and the lens (the front capsule), a complete infection of the pupil hole may occur.

Interestingly, synechia can be formed both with natural lens and after an IOL transplantation surgery. The degree of battles varies depending on the severity and duration of the inflammatory disease.

At the beginning of the formation of battles, the effectiveness may exhibit various proteolytic enzymes, which include fibrinolysin, chymotrypsin, lectures, tripsin, streptodecase and collalizine. At the same time, it is important not so much the proteolytic effect of the drug, how much to increase the permeability of tissues for nutritional compounds, as well as the inhibition of the formation of connective tissue cells in the field of inflammation.


In the treatment of synechs, a lidase is used, which leads to the improvement of fluid properties of hyaluronic acid. In addition, it increases the permeability of tissues for the intercellular fluid. As a result, the latter in less accumulates in this area.

For enzymotherapy, traditional methods are used (droplet instillation, injection of the parabulbar region or under conjunctiva) or physiotherapy methods (phonophoresis, electrophoresis). Additionally apply local or systemic introduction of angioprotectors.

Cytoplagic preparations (mydriatics), which include homatropine (the action is similar to atropyne) are used at rear syneficia. These means retain the pupil in an extended state, as a result of which it is at some distance from the lens capsule. In this way, the fighting is prevented. If there is a synech, the administration of atropine-like drugs leads to a change in the shape of the pupil hole. It becomes not round. The forecast of the disease is determined by the degree of opening of the hole under the influence of drugs. When full opening - The forecast is favorable, that is, the fights are reversible.

For the purpose of anti-inflammatory therapy, corticosteroids are prescribed. With an increase in intraocular pressure to therapy, anti-robbery drugs (Fotyl, Trava) are added.


To the surgical dissection of battles with the help of a scalpel, spatula, scissors are resorted in more serious cases. In order to prevent the development of glaucoma, such manipulation can be performed as an independent intervention. Sometimes it is part of other operations (cataract treatment, iris plastic, reconstruction of the front eye of the eyeball).

In the presence of dense and massive battles, you need to use the scissors of the bath and the iris scissors. They penetrate the front chamber of the eye through a small incision in the field of limb, which is carried by a special kerat. The incision should be in close proximity to the synech, but not opposite them. If there are vessels inside the synefic, that is, it is vascularized, the hypham can be formed during the dissection.

If the rear battles are located behind the intact iris, then they should be dissected very carefully, so as not to damage the lens capsule.

Old synechs after surgery can cause an aggravation of inflammation (iridocyclitis, irita), in connection with which postoperative period It is necessary to conduct treatment with cortisone and atropine.

IN medical center "Moscow Eye clinic"Everyone can undergo a survey on the most modern diagnostic equipment, and according to the results - to obtain a consultation of a high-class specialist. The clinic is open seven days a week and works daily from 9 h to 21 hours. Our specialists will help identify the reason for reducing vision, and will be competent treatment of identified pathologies.

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What is iridocyclitis

Iridocyclitis is inflammation that affects the iris and the ciliary body of the eyeball. Entires also include Irit, Keratouweet and cyclit.

Since the iris and the ciliary body are closely related to anatomically and functionally, inflammation that began in one region of the vascular shell is quickly distributed to others. There is acute and chronic iridocyclites. Acute inflammation It lasts 3-6 weeks, and chronic - several months. For iridocyclitis, exacerbations and relapses in the cold season are characterized.

The inflammation of the vascular shell is accompanied by immune cytolysis (cell destruction) and vasculopathy (vessel change). Iridocyclite ends with the scarring of the shell and dystrophy of the elements of the eye. With inflammation, the vascular shell is amazed by microbes and their toxins. Immunological disorders are also occurring with the participation of the inflammatory mediators (substance transmitting nerve impulses).

Types of inflammation in the nature of the change:

    • serous;
    • hemorrhagic;
    • exudative;
    • fibrino-plastic.

Inflammation of the vascular shell of the eye can develop in patients of any age, but most often the condition is diagnosed in persons of 20-40 years. Ethiology differences infectious inflammation, allergic, allergic noncommunicable, post-traumatic and iridocyclites of unclear etiology.

Causes of iridocyclitis

Inflammation of the vascular shell eye can be due to both external and internal factors. Often, iridocyclite is the consequence of injury and inflammation of the iris. The provoking factors include endocrine disorders, immune failures, stress, supercooling, excessive physical activity.

What diseases can cause iridoclite:

    • flu;
    • tuberculosis;
    • measles;
    • toxoplasmosis;
    • malaria;
    • urinary infections (gonorrhea, chlamydia);
    • rheumatoid pathologies (rheumatism, Bekhterev's disease, still disease);
    • metabolic disorders (diabetes, gout);
    • chronic nasopharynx infections and oral cavity (sinusitis, tonsillitis);
    • systemic diseases (sarcoidosis, behanet disease).

Often, eye inflammation is developing against the background of the activity of herpes virus, staphylococcal and streptococcal infections, various bacteria. It is noteworthy that iridocyclite is found in 40% of patients with infectious and rheumatic diseases.

Symptoms of iridocyclitis

The severity of inflammation and the features of its flow will depend on the etiology and duration of the disease. The severity of iridocyclite is also determined by the immune status, the genotype and the level of permeability of the hematophthalmic barrier (separation between blood vessels and elements of the eyeball).

General symptoms of acute iridocyclitis:

    • severe swelling;
    • pain;
    • redness;
    • increased tear;
    • deformation of the pupil;
    • changing the color of the iris;
    • impairment;
    • the formation of hypocion (pus in the front chamber) and precipitates (cell accumulation on the surface of the iris).

For iridocyclitis, one-sided defeat is characterized. The first signs of inflammation become redness and discomfort, which develops into pain. The pain syndrome is enhanced with mechanical effects on the eyes. Patients with iridocyclite complain of light-free, climony, tearing and minor deterioration in the visual function.

When developing iridocyclitis, the color of the iris is changing, the clarity of its drawing decreases. In some patients there is a cornea syndrome (tear, light-dining, blefarospasm). When examining, the doctor can identify serous, purulent or fibrinous exudate in the anterior chamber of the eyeball.


After breaking the vessel in the front chamber, blood accumulates (gifema). When the pus is at the bottom of the chamber, a hyponone (gray or yellow-green strip) is formed. When the exudate is sedentised on the lens or the vitreous body, these elements may be poisoned, which will cause impairment.

Iridocyclite causes the appearance of grayish-white precipitate on the rear wall of the cornea. These are point deposits of various cells and exudate. If the enemy iris is closely in contact with the lens, if there are exudate, synechia (spikes) are formed, which provoke a narrowing and deformation of the pupil. Accordingly, the reaction to light worsens.

If the iris growls with a crystal over the entire surface, a large circular spike is formed. Launched iridocyclite complicated with synefishes can be dangerous with blindness with full infection of the pupil.

With inflammation of the iris, a reduced intraocular pressure is often marked. This is due to the oppression of the process of secretion of the eye moisture in the front chamber. Acute iridocyclite, complicated by pronounced exudation or the smell of the pupil edge, can vice versa to increase the pressure in the eye.

Clinical picture of different types of iridocyclite

Different types of iridocyclitis differ in symptoms. In viral etiology, the disease most often has a trapid flow: intraocular pressure increases, serous or serous-fibrinous exudate is formed, light precipitates arise. For tuberculous inflammation of the iris, a weak severity is characterized: large precipitates, tuberculos on the iris, increases the transmission of intraocular fluid (opalescence), there are powerful synefishes, vision is bold.


Autoimmune iridocyclite often has a difficult course, differs frequent relapses against the background of exacerbation of the main disease. Inflammation in the eye caused by autoimmune pathologies often end with complications (cataract, keratitis, secondary glaucoma, scarce, eye atrophy). It is noteworthy that every new recurrence is heavier than the previous one, which significantly increases the risk of blindness.

Traumatic iridocyclite in most cases provokes sympathetic inflammation: pronounced exudation, infection of pupil, cataract and glaucoma, significant impairment of vision. With a relay syndrome, which is due to the activity of chlamydia, the iridocyclite is often combined with urethritis, conjunctivitis and lesions of the joints. Symptoms of inflammation of the vascular shell may be present.

Diagnosis of iridocyclitis

Put the correct diagnosis only after comprehensive examination not only visual, but also other organism systems. In addition to ophthalmic methods, laboratory and diagnostic should also be carried out. It may take advice from narrow-profile specialists.

Methods of diagnosis of iridocyclite:

    1. Biomicroscopy (a detailed study of all the structures of the eyeball).
    2. Ultrasound examination of the eyeball.
    3. Visiter (check of visual acuity).
    4. Tonometry (measurement of intraocular pressure).
    5. Clinical and laboratory methods.
    6. Immunological studies.

First of all, the ophthalmologist examines the eyeball of the eyeball and analyzes the history of the patient. It is very important to check the visual sharpness, determine the level of intraocular pressure and conduct biomicroscopy, which will allow you to estimate the condition of the elements of the eye. Ophthalmoscopy with inflammation of the iris is ineffective, since the front eye of the eye is significantly changed.

To identify the cause of iridocyclitis, prescribe blood and urine test, allergic and rheumatic samples, coagulogram. It is important to check the body's reaction on streptococcal allergens, staphylococcus, tuberculin and other specific agents.

The method of polymerase chain reaction and IFA diagnostics allow you to identify syphilis, herpes, tuberculosis, chlamydia and other diseases that may cause iridocyclitis. You can check the immune status using the determination of the level of immunoglobulins in the blood (IGM, IGA, IGG). If necessary, prescribe x-ray of lungs and sinuses of the nose.

According to the results primary diagnosis Consultations of such specialists can be appointed:

    • rheumatologist;
    • otolaryngologist;
    • allergist;
    • dentist;
    • pTICIATR;
    • dermatovenerologist.

Differential diagnosis makes it possible to eliminate ophthalmic pathologies that are accompanied by swelling and redness of the eye. This is acute conjunctivitis, primary glaucoma and keratitis.

Emergency Aid with an acute attack of iridocyclitis

First of all, the doctor must inspect. The main symptom, which makes it possible to distinguish iridocyclite from Irita, is ciliary pain (occurs when the eyeball appears through the eyelid). Such pains are present for the reason that ciliary bodyinvolved in the process of inflammation during iridocyclite, adjacent to the sclera and is easily adjusted when feeling. When Irite (insulated inflammation of the iris), there are no pains, because the iris is separated from the wall of the eye of the water watery moisture.

In addition, the symptoms of iridocyclitis is more pronounced. The first thing you need to drip a solution of decxazone (0.1%), as well as an atropine or homatropine solution (1%). If the patient complains of severe pain, you need to bore dicain (0.25% drops or a solution of 0.5%). On the eye impose a bandage to protect against light and cold. For further treatment, the patient is delivered to the hospital.

Therapeutic treatment of iridocyclitis

Only timely and competent therapy can guarantee full cure. The main task is to eliminate the cause of inflammation. In case of iridocyclite, antibacterial, anti-inflammatory and antiviral drugs. If necessary, therapy is complemented by antihistamine, hormonal and disinfectants, as well as vitamins, mydriatics and immunomodulators.

Conservative treatment makes it possible to prevent the formation of synechs, and also reduces the risk of complications. In the first hours, you should bury drugs that contribute to the expansion of the pupil (mydriatic). Nonteroidal anti-inflammatory and corticosteroids are prescribed to the patient, if necessary, antihistamines.

The treatment of iridocyclitis should be carried out in a hospital. Requires general and local exposure: antibacterial, antiseptic and antiviral. Non-steroidal anti-inflammatory I. hormonal drugs can assign in different forms ( eye drops, injections). With toxic-allergic or autoimmune iridocyclite, corticosteroids are needed.

The inflammation of the iris does not pass without disinfecting therapy. In pronounced flow, plasmapheres or hemosorption is required. Instillations by mydritis help to prevent the battle of the iris and the crust capsules. Additionally assign multivitamins, antihistamines, Immunosuppressors or immunostimulants.

In case of iridocyclitis, physiotherapy will be effective. Depending on the causes of inflammation, such procedures can be appointed: electrophoresis, laser impact, magnetotherapy. For resorption of exudate, adhesions and precipitates are needed by local proteolytic enzymes. Iridocyclite, due to syphilis, tuberculosis, toxoplasmosis or rheumatism, requires specific treatment.

Treatment of synechs with iridocyclite

On the initial stage Proteolytic enzymes (tripsin, chymotrypsin, lectures, fibrinolysin) show themselves the formation of battles. These drugs are not only cleaving proteins, having a proteolytic effect, but also increase the permeability of eye fabrics for beneficial substances and brake the education process connective tissue. It is possible to use angioprotectors.

Enzyme therapy can be carried out by standard methods (drops, injections) or physiotherapeutic (phonophoresis, electrophoresis). The rear synechs of the iris are eliminated by means of mydriatics. They allow you to expand the pupil and save it in such a state so that the edges of the iris are removed from the lens. This allows you to prevent the emergence of new battles. The reaction of the pupil to the introduction of mydriatics gives a forecast: if there is a complete disclosure, the spikes can be eliminated.

If the formation of synechs is combined with elevated intraocular pressure, the patient prescribe eye drops against glaucoma. You should also take corticosteroids to combat inflammation.

In severe cases, surgical dissection is required in the eye. Such an operation can be self, or enter a set of measures to eliminate cataracts, iris defects or anterior segment elements. In the treatment of solar synechs there is a high risk of postoperative inflammation.

Operation for iridocyclite

Surgical elimination of inflammation is necessary in the case when there are spikes or a secondary glaucoma is developing. With purulent iridocyclite, complicated by lysis of shells and eye elements, the eye apple is removed (evisceration, enucleation).

Evisceration Eyes - surgical removal The contents of the eyeball. The operation is shown at a high risk of developing severe purulent processes. After removing the contents of the eyeball, it is recommended to insert the eye prosthesis. Evisceration provides a good cosmetic effect. After the operation, a movable cult and the natural fastening of the muscles to the scler is preserved.

Enucleation is shown only in extreme cases. Most often, the operation is prescribed to patients with traumatic iridocyclitis, when there is a high risk of sympathetic inflammation in healthy eye. Also removal is necessary if malignant tumor or strong pain In a blind eye. The removal of the eyeball is not carried out with a panofalt, because there is a risk of infection with the eye and brain.

Prevention and forecast

Recovery can only be achieved with timely, full and adequate treatment of iridocyclitis. Acute inflammation can be cured completely only in 15-20% of cases, and in 50% it goes into a subacute stage with relapses against the background of the exacerbation of the disease, which caused.

Often, iridocyclite goes into a chronic form, which leads to a resistant reduction in visual acuity. Without treatment, inflammation is fraught with hazardous complications threatening not only visual, but also other systems of the body.

Complications of launched iridocyclitis:

    • infection pupil;
    • secondary glaucoma;
    • cataract;
    • retinal disinsertion;
    • chorioretinite;
    • deformation or abscess of the vitreous body;
    • endophthalm;
    • panofalmita;
    • subatrophia, eye atrophy.

The prevention of inflammation of the iris implies timely diagnosis and treatment of diseases that can cause iridocyclitis. It is very important to sanitize the foci of chronic infection in the body, in particular the nasopharynx infections and the oral cavity.

Iridocyclite Prevention:

    • full-fledged treatment and prevention of infectious, inflammatory and viral diseases;
    • protection of the visual system from injuries;
    • timely diagnosis of complications after eye injury;
    • strengthening the immune system;
    • preventing supercooling.

Often, iridocyclite acts as a manifestation of another disease, therefore, first of all, it is necessary to find the cause of inflammation. Most dangerous disease It may be in the cold season, so during this period you need to carefully protect the body.

Treatment of synech rainbow

At the initial stage of the formation of the synech eyes, proteolytic enzymes possess sufficient efficiency. This group includes such drugs such as chymotrypsin, fibrinolysin, trypsin, lectures, collalizin, streptodecadis. Not only the proteolytic effect of these drugs is important, but also an increase in the permeability of eye tissues for nutrientsIn addition, under their action, the further formation of the connective tissue in the zone of the pathological process is slowed down.

Lydase, used in the treatment of blue iris, provides an improvement in the flow of the hyaluronic acid properties. Due to the increase in the permeability of tissues in the pathological region, fewer liquid accumulates. Enzymerapy can be carried out as using standard methods (Instillations eye drops, parabulbar and subconjunctive injections) and physiotherapy techniques (electric and phonofrez). Angioprotectors are also used systemically or locally.

In the presence of rear synechs of the eye iris, Midships are used (homatropine) - cyclopelic drugs, the action of which is similar to that of atropine. These drugs retain the pupil expanded, due to which the edges of the iris are located on a cleaner distance removed from the leakage. This is how the prevention of further fight is carried out. If the rear syneficia occur, the introduction of an analogues of atropine leads to a violation of the rounded form of the pupil - it becomes the wrong shape. The forecast of the disease is determined by the answer of the pupil on the introduction of cyclopelgic means: if it is completely revealed, the syneficia is completely reversible.

With anti-inflammatory purposes apply corticosterides. In the case of increased intraocular pressure, anti-erochored eye drops are prescribed (trawatat, fotil and others).

In severe clinical cases, surgical dissection of the synechnia eye with the help of scissors, scalpel and spatula. This operation can be carried out as an independent intervention or be part of the complex surgical operation With the treatment of cataracts, plastic iris, reconstruction of the front segment of the eye. In the case of old blue iris in the postoperative period, there is a risk of inflammatory complications: Irita, iridocyclitis.

Normally, the intraocular fluid comes from the rear chamber of the organ of vision in the front. Pathological processes in the vascular shell lead to the formation of circular adhesions between and, which prevents the transition of the liquid. Accumulating B. rear chamberThe latter leads to the protrusion of the iris outward - the bombing of the iris is observed.

Most often, the described pathology is secondary, acting by the consequence of late treatment of eye diseases. If you believe the statistics, the phenomenon provocateur most often turns out to be inhabited, leading to a visual splicing of iris with a lens.

What is the bombing of the iris?

Bombing iris - The pathological process at which there is a violation in the structure of the anterior chamber of the organ of vision. The disease is developing against the background of increased intraocular pressure and, in the exclusion of appropriate treatment, it may cause complete loss of vision.

The reasons

Among the roots causing deviationAllocate:

  1. Development of the inflammatory process of vascular eye shell . Inflammation contributes to the production of fibrin and protein compounds provoking the process of formation of adhesions.
  2. Education of vascular sheath tumorswhich are the reason for activating a minor inflammatory process, which also leads to the formation of adhesions between the main structural elements of the eye.
  3. Eye injury. The iris bombing may arise in response to the defeat of the pupil membrane.

Symptoms

The disease is accompanied by:

  • significant pain syndrome;
  • decrease in visual acuity;
  • redness of the eyeballs;
  • blefarospasm;
  • photoFobia (fear of light);
  • elevated and eye irritation.

Diagnostics

The bombing of the iris eye is diagnosed by the following instrumental methods:

  • visometrium;
  • conventional visual inspection;
  • biomicroscopy;
  • tonometric.

The following laboratory studies can also be assigned:

  • determination of glucose value in the blood;
  • identification of immunoglobulin to hepatitis B;
  • general blood analysis;
  • serological test for syphilis;
  • general analysis Urin.

When identifying concomitant pathologies, it is necessary to pre-consult with a therapist or a narrow specialist.

Diseases

Pathological deviation may be accompanied by the progression of the following diseases:

  • iridocyclit. Inflammatory process In the iris or ciliary body, significantly increases the risk of splicing the edges of pupils with a lens;
  • sinechia. The process becomes the cause of difficult outflow of intraocular fluid, or its full blocking;
  • pupil block. The deviation, which is accompanied by a significant difficulty or blocking of fluid flow between the eye cameras through the pupil.

Treatment

Depending on the severity of a particular case, both conservative and operational therapy can be used.

Conservative treatment

The basis of therapy is the use of drugs that contribute to the establishment of a normal intraocular pressure:

  • oral use - diakarb and its analogues;
  • intravenous administration - mannitol, glucose, etc.;
  • local use - Timolol, Azopt, etc.

Surgical intervention

If necessary, resort to the appointment of the following types of operations:

  1. Iridectomy. In the process of operational intervention, a microscopic through hole is formed in a rainbow shell to provide outflow of intraocular fluid and pressure normalization. The operation is carried out using a laser or surgical method.
  2. Sinehiotomy. Elimination of adhesions with laser or surgical path.

To assess the effectiveness of the operational intervention of the patient, the patient must be under the control of hospital specialists at least a week. If, according to the results of the operation, the normalization of pressure inside the eye and the decline in the process is observed, the treatment is recognized effective.

Thus, the described phenomenon is a defect in the structure of the front chamber due to a failure in the process of moving the eye fluid. Pathology occurs more often on an uveit background. Therapy of the disease implies oral, intravenous and local use of funds to normalize the pressure inside the eye. In some cases, the patient shows the operation.

The bombing of the iris may occur against an uveit background. When progressing this pathology, the functioning of eye cameras is disturbed. The bombing is dangerous by what can lead to loss.

Causes of the disease

The predisposing factor are synechia. There are cases when the bombing occurs during the damage to the pupil membrane, which is why the pupil unit is formed. The pupil membrane can shift the ciliary body process.

If Iradocyclite is observed, the edge of the pupil is spliced \u200b\u200bwith part of the lens. In the absence of lens, a certain part of the pupil is spliced \u200b\u200bwith a vitreous body. The bombing can lead to the complete closure of the pupil.

As a result, serious ophthalmic problems will arise. Unlike other pathologies that have similar symptoms, the bombing is characterized by a sharp increase in intraocular pressure.

Peripheral front synechnias is formed when the rainbow shell is sprung with a cornea or trabecular network. The formation of the front synechs disrupts the outflow of intraocular fluid. The outflow of intraocular fluid may stop completely.

Peripheral front syneficia often occurs on an uveit background. They also appear in people having a narrow angle of the front chamber. The rear synefishes are formed during the sink of the rear section of the iris and the shell of the crust.

Repeat will increase the likelihood of the synefy. The pupil block is a pathological formation that affects the outflow of intraocular fluid.

This block violates the functioning of the organs of vision, in particular, this is due to the formation of the rear synechs. Due to the fact that the volume of intraocular fluid increases and intraocular pressure increases, the iris bombing occurs.

With a rapid increase in intraocular pressure, the iris starts to fake into the front chamber area. Inflammatory reactions lead to the fact that the angle of the eye closes. As a result, peripheral synefishes are formed by such a problem.

Against the background of uveitis formed big sobbing. The rainbow sheath is significantly spliced \u200b\u200bwith a part of the lens. The peripheral region of the iris becomes bent, as a result, serious ophthalmic problems arise.

Diagnosis and conservative treatment

Bombing iris requires comprehensive diagnostics. Patient suffering from uvelet needs to be observed by the doctor. To diagnose the bombing, it is necessary to conduct an ophthalmological inspection.

The doctor prescribes isometry, biomicroscopy and tonometry. To identify the disease, a serological study on syphilis is required, detecting antibodies to hepatitis B, urine and blood tests. It is important to inform the doctor about the ailments that could aggravate the course of uveit.

If an ophthalmologist reveals a bombing, conservative or surgery. Depending on the features of visual organs, funds are selected: drug diakar can be written in tablets.

Sodium chloride is appointed for intravenous administration. A good result gives drops with adrenaline and atropine. In the fight against illness effective corticosteroidal funds. purpose medical treatment - Restore intraocular pressure, eliminate the pupil unit.

Other methods of therapy

Depending on the degree of eye damage, the doctor may appoint an iridectomy. Surgical manipulation is shown if the cornea is transparent and the eyeball is not too inflamed. Laser iridectomy is recommended for patients with pseudofakic eyes. Other types of operations are conducted in faky eyes.

Surgered surgical procedure is laser iridectomy. Thanks to its capabilities, it is possible to restore the functioning of the eye chambers. The result of the procedure is the elimination of the pupil unit.

To carry out this operation, you need to make several holes on the surface of the eyes. After the procedure, the patient is observed at the doctor. Throughout the period you need to control vision. Surgical iridectomy is performed at the impossibility of laser treatment.

The patient is also observed by a doctor. If there are no inflammatory reactions, it means that the operation gave good result. To evaluate the effectiveness of the procedure, you need 7 days to observe the patient.

There are situations where a crystal is damaged during the intervention. If the operation gives any complications, the patient goes to the hospital, which lasts 1 month. After that, you need to get up on the dispensary accounting of the ophthalmologist.

The bombing of the iris often occurs during eye pathology. In order to avoid this ailment, the remaining ophthalmological diseases should be treated in a timely manner.

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The closedian glaucoma (zag) is about 20% of the primary glaucoma cases and is usually developing over the age of 40. Women get sick more often than men.

Etiology. The reasons for increasing the WGD are the closure of the angle of the anterior chamber, the contact of the peripheral part of the iris with the trabecular. The etiology of primary closed glaucoma is also associated with a large number of factors including:

1) individual anatomical features;

2) age-related changes in various structures eyes;

3) the state of the nervous and endocrine system.

Anatomical predisposition is due to the small size of the eyeball and anterior chamber, a large size of a lens, a narrow angle profile of the anterior chamber. The closedian glaucoma develops significantly more often in individuals with hypermetropy, since the anatomical features of the eyes with such a type of refractive contributes to its development.

Agends include an increase in the thickness of the lens due to its swelling, as well as destruction and an increase in the volume of the vitreous body.

Functional factors, such as: expansion of the pupil in an eye with a narrow angle of the anterior chamber, an increase in the production of water-insulated moisture and an increase in the blood flow of intraocular vessels, directly determine the closure of the angle of the anterior chamber.

Pathogenesis. With a pupil unit (due to the contact of the rear surface of the iris with the front chamber of the lens in the pupil area) there is an obstacle to the outflow of water-melting moisture from the rear chamber to the front through the pupil. This leads to an increase in pressure in the rear chamber compared to the front. As a result, a thinner peripheral part of the iris sputters the kleon (bombing) and comes into contact with Trabecuch. The angle of the anterior chamber is closed, leading to a significant increase in the WGD, and with the circular block of trabecular outflows - to the acute attack of glaucoma.

Classification and clinical picture. The four main forms of primary closed glaucoma distinguish:

1. With the pupil unit.

2. With flat iris.

3. "Creeping".

4. With a vitreohrustal block.

1. Primary Clothing Glaucoma with a pupil unit It is found in more than 80% of cases of closed-coronal glaucoma. There is a middle or older person in the type of acute or subacute attack, with the transition further into chronic formulas. Risk factors are hypertropy, small size Eyes, small front camera, narrow angle of the front chamber, a large crystal, thin peripheral part of the iris, the front position of the ciliary body and iris root.

As a result of the contact of the rear surface of the iris with the front capsule of the lens in the pupil area, an obstacle arises for the outflow of water-melting moisture from the rear camera to the front. This leads to an increase in the BGD in the rear chamber compared to the front. Due to the accumulation of water-melting and increase the pressure, the peripheral part of the iris is strung out the kepened and overlaps the trabec zone. The angle of the anterior chamber closes, rises ingd up to a sharp attack.

Most often, the immediate cause of the acute attack of glaucoma is: emotional excitation, long-term and hard work with a head slope, staying in a darkened room, receiving a large amount of fluid, supercooling or receiving exciting drugs.

Usually the attack is developing in the afternoon or in the evening. The patient begins to celebrate the bold of view, the appearance of rainbow circles when looking at the source of light. The main complaint - pain in the eye, irradiant in the course trigeny nerve In the forehead area and the head rug of the lesion. Of common symptoms The slowdown in the pulse, nausea, sometimes vomiting, which is associated with the excitation of parasympathetic innervation.

Objectively, first there is an expansion of episkleral vessels, and in the future a stagnant injection is developing, at which not only the front seafrine of artery is expanding, but also their branches (Fig. 1). The cornea becomes edema (due to epithelium edema and stroma), less sensitive; The front chamber is shallow, the waterproof moisture loses its transparency (due to the length of the protein). The iris is domesticized, the drawing becomes dull and smoothed; The pupil is expanding and becomes often incorrect form, the reaction of the pupil is missing. Purplement appears in the lens in the form of white spots located mainly in the front and medium subcapsular layers.

The edema of the cornea makes it difficult to inspect the elements of the eye bottom, however, you can consider the ward spectator nerve, extended veins of retina; In some cases, hemorrhages in the area of \u200b\u200bthe optic nerve disk and paraventional retinal areas.

Fig. 1. Acute glaucoma attack

During this period, the WGD reaches a maximum value and increases to 50-60 mm Hg. Art., With a gonoscopic examination, the anterior chamber's angle is closed throughout. Due to the rapid increase in ophthalmotonus and a significant compression of the iris root in the root, a segmental circulatory disorder in radial vessels with signs of necrosis and aseptic inflammation occurs in the rootoscleral zone.

It is clinically manifested by the formation of the rear synechs along the edge of the pupil, the appearance of goniinehih, focal atrophy of the iris, deformation and the displacement of the pupil. The reverse development phase of the attack is due to a decrease in the secretion of water-linked moisture and leveling the pressure between the front and rear chamber (the diaphragm of the eye shifts the overhead, the bombing of the iris, the angle of the front chamber is partially or fully opened). Goniinechia, segmental and diffuser atrophy of the iris, offset and the deformation of the pupil remain forever. These consequences affect the further course of the glaucoma process and during repeated attacks lead to the development of chronic closed-curved glaucoma with constantly elevated WSA.

Differential diagnosis The acute attack of glaucoma and acute iridocyclitis is shown below.

Table 1

Differential diagnosis of acute gloomy attack and acute iridocyclitis

Acute iridocyclite

Complaints on the "rebel" in front of the eye

Fog complaints before eye

Rainbow Circles when looking at the light

Bulk vision

Pain in the eye, irradiating in the same half of the head

Pain syndrome prevails in the head

Possible nausea and vomiting, pain in the field of heart, in the stomach

Not observed

Promotion of longitudinal attacks

The disease begins suddenly

Stagnant injection of vascular eyeballs

Perikornal injection

The sensitivity of the cornea is reduced

The sensitivity of the cornea is not changed

Front camera small

Middle Depth Front Camera

Pupil is wide. The reaction of the pupil is missing

The pupil is narrow, when the extension may be incorrect form. The reaction of the pupil on the light is sluggish

Rainbow Sheath Even, Vessels Expanded, Miscellaneous

Rainbow shell is changed in color, drawing and relief smoothed

Complicated cataract (after a sharp attack)

On the front capsule lens deposition of filaments or fibrin films

WGD increased significantly

Vguards within normal limits or reduced

Edema of a vitreous body

The vitreous body is transparent, possibly preventions, fibrin

Disk of optic nerve edema, veins are extended; Disk area and retina are possible

Opening nerve disc is not changed

Potted attack glaucoma It is characterized by the same symptoms, but they are expressed significantly weaker due to the fact that the angle of the anterior chamber is blocked not throughout. The pressure in the eye increases to a lesser extent, therefore, after the attack, the rear and bandiosinechia are not formed. Subacute attacks will be bought using drugs. Subacute and sharp attacks can replace each other over time. As a result of the formation of goniinehih, the blockages of Trabez and the helmet of the channel, the disease acquires a chronic character with a persistent increase in the level of IOP.

2. Clotted glaucoma with flat iris It is found in 5% of cases of primary closed-coronal glaucoma. Arises between the ages of 30 and 60 years. The main anatomical predisposing factors include excessive thickness of the peripheral part of the iris, the front location of the Corona Corona Ciliaris in the rear chamber, the front position of the iris root, cool iris profile, the very narrow angle of the front chamber of the bevoid configuration. The course of the disease is first sharp and then chronic. The attacks occur when expanding the pupil and the direct blockade of the angle of the angle of the front camera root of the iris. A violation of the outflow of water-melting moisture from the anterior chamber is developing with an increase in pressure in it. The iris remains flat, the depth of the chamber does not change.

3. "Creeping" Clothing Glaucoma It develops in 7% of patients with a closed gloomy, mainly in women. Proceeds as chronic illnessBut sometimes sharp and subacute attacks arise. It is based on the root of the angle of the anterior chamber due to the fuel root of the iris with the front wall of the corner: the base of the iris "crawls" on the trabecula, form a fixed front synechia. As a result, the outflow of watery moisture from the anterior chamber is disturbed and increases ing.

4. Clotted glaucoma with a vitrehtrastakov block Diagnosed relatively rarely. It may be primary, but more often develops after antiglauucomatous operations in patients with anatomical features of the eye structure (small eye size, large lens and massive ciliary body) and with hypermetropy. Clinical picture Skhodny S. acute attack glaucoma. For ultrasound exam reveal a violation of the structure of the front chamber and the cavity in vitreous body With a cluster of water and moisture.

Diagnostics. For the diagnosis of all forms of closed gloomy, load samples are used - dark and positional.

While doing dark Toma The patient is placed on 1 h in a dark room. The sample is considered positive if during this period of the WGD will increase by at least 5 mm RT. Art. The effect of the dark sample is associated with the expansion of the pupil in the dark and the cover of the drain zone by a section of the abbreviated iris.

When conducting positional test The patient laid on the couch face down for 1 h. Increased VGD by 6 mm RT. Art. and more indicates a predisposition to the blockade of the angle of the anterior chamber. The effect of the positional sample is explained by the displacement of the lens towards the front chamber.

Zabedov GD, Skripting R.L., Baran T.V.

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