Iridocyclitis, also known as anterior uveitis, is an inflammatory condition affecting the iris and ciliary body. It is a common form of uveitis, leading to eye pain, redness, photophobia, and vision disturbances. If left untreated, it can cause severe complications, including glaucoma, cataracts, and permanent vision loss. Understanding its causes, symptoms, diagnosis, and treatment is crucial for early management and prevention of long-term ocular damage.
What Is Iridocyclitis?
Iridocyclitis is a form of anterior uveitis, characterized by inflammation in the iris (colored part of the eye) and ciliary body (structure responsible for aqueous humor production and lens focusing). This condition can be acute or chronic, affecting one or both eyes.
Causes of Iridocyclitis
Iridocyclitis can develop due to autoimmune disorders, infections, trauma, or systemic diseases.
1. Autoimmune and Inflammatory Diseases
- Ankylosing Spondylitis – Strongly linked with HLA-B27 gene.
- Rheumatoid Arthritis – Immune-mediated attack on eye structures.
- Sarcoidosis – Granulomatous inflammation affecting multiple organs.
- Inflammatory Bowel Disease (IBD) – Includes Crohn’s disease and ulcerative colitis.
2. Infectious Causes
- Herpes Simplex Virus (HSV) and Herpes Zoster Virus (HZV)
- Tuberculosis (TB) – Granulomatous uveitis
- Syphilis – Treponema pallidum infection
- Toxoplasmosis – Parasitic infection affecting the retina
3. Ocular Trauma and Surgery
- Blunt or penetrating injuries leading to post-traumatic uveitis.
- Complications from cataract or glaucoma surgery.
4. Drug-Induced Iridocyclitis
- Rifabutin (used for TB treatment)
- Cidofovir (antiviral drug for cytomegalovirus infections)
- Bisphosphonates (used for osteoporosis treatment)
Symptoms of Iridocyclitis
Iridocyclitis symptoms can develop suddenly or progress gradually, depending on the underlying cause.
| Symptom | Description |
|---|---|
| Eye Redness | Inflammation leads to conjunctival and episcleral hyperemia. |
| Eye Pain | Deep, aching pain due to ciliary muscle spasm. |
| Photophobia | Sensitivity to light caused by iris movement irritation. |
| Blurred Vision | Inflammatory cells in the aqueous humor impair clarity. |
| Floaters | Presence of inflammatory debris in the vitreous. |
| Tearing | Increased lacrimation due to irritation. |
Pathophysiology of Iridocyclitis
Iridocyclitis occurs due to immune system activation or direct infection, leading to the release of inflammatory cytokines that damage ocular tissues.
Diagnosis of Iridocyclitis
A thorough clinical evaluation and diagnostic tests are essential for confirming iridocyclitis and identifying its cause.
1. Slit-Lamp Examination
- Detects cellular infiltration in the anterior chamber.
- Identifies keratic precipitates (WBC deposits on the corneal endothelium).
- Evaluates iris nodules and synechiae formation.
2. Tonometry
- Measures intraocular pressure (IOP) to rule out secondary glaucoma.
3. Fundoscopy
- Assesses vitreous, retina, and optic nerve involvement.
4. Laboratory Tests
- HLA-B27 Testing – If associated with spondyloarthropathies.
- Serology for Syphilis and TB – To rule out infectious causes.
- Antinuclear Antibody (ANA) Test – If systemic autoimmune disease is suspected.
5. Optical Coherence Tomography (OCT)
- Evaluates macular edema and retinal complications.
Treatment Options for Iridocyclitis
The goal of treatment is to reduce inflammation, alleviate symptoms, and prevent complications.
1. Corticosteroids (Anti-Inflammatory Therapy)
- Topical Prednisolone Acetate (1%) – First-line treatment.
- Periocular or Intravitreal Steroids – For severe cases.
- Oral Corticosteroids – Used if systemic involvement is present.
2. Cycloplegic Agents (Pain and Photophobia Control)
- Atropine 1% or Homatropine 5% – Relaxes ciliary muscle, reducing spasms.
- Prevents Posterior Synechiae Formation (adhesion of the iris to the lens).
3. Immunosuppressive Therapy (For Autoimmune Cases)
- Methotrexate, Azathioprine, or Mycophenolate Mofetil – Used in chronic cases.
- Biologic Agents (Adalimumab, Infliximab) – Effective for refractory uveitis.
4. Antibiotics and Antivirals (For Infectious Causes)
- Antibiotics for Syphilis and TB.
- Acyclovir or Valacyclovir for Herpetic Iridocyclitis.
5. Surgical Interventions
- Pars Plana Vitrectomy – In cases of persistent vitritis or retinal detachment.
- Cataract Surgery – If complications arise due to chronic inflammation.
Complications of Iridocyclitis
If untreated, iridocyclitis can lead to severe vision-threatening complications.
| Complication | Description |
|---|---|
| Glaucoma | Increased IOP due to trabecular meshwork blockage. |
| Cataracts | Lens opacification due to chronic inflammation or corticosteroid use. |
| Macular Edema | Fluid accumulation in the retina leading to vision loss. |
| Retinal Detachment | Severe cases may cause separation of the retina. |
Prevention Strategies
- Early diagnosis and treatment of underlying autoimmune diseases.
- Regular eye exams for high-risk individuals.
- Protective eyewear to prevent traumatic iridocyclitis.
- Avoiding self-medication with corticosteroids without medical supervision.
Iridocyclitis is a serious ocular inflammatory disorder that requires prompt diagnosis and treatment to prevent vision loss. By addressing the underlying cause and managing inflammation effectively, patients can maintain good visual function and minimize complications. Routine ophthalmic examinations and early intervention are key to reducing the burden of anterior uveitis on long-term eye health.
