Ophthalmology

Inflammation of the iris

introduction

The iris, which one too iris is the pigmented aperture of the eye. It is the front part of the middle skin of the eye. This middle eye skin is known as Uvea. In addition to the iris, the uvea also includes the radiation body (Corpus ciliary) and the choroid (Choroid). The iris separates the anterior and posterior chambers of the eye and its inner part encompasses the pupil. In this way, it regulates the amount of light entering the eye.

definition

In the Iritis is it a Inflammation of the iris (also Iris inflammation called). It is often associated with Inflammation of other parts the middle skin of the eye (Uvea), which are then called in their entirety Uveitis designated.

One distinguishes two ways of origin the iritis. On the one hand there are Iritides, one of them non-inflammatory cause on the other hand can inflammatory diseases as part of the immune response after infections occur.

Iritis of non-inflammatory origin

Many autoimmune diseases can cause iris inflammation. The autoimmune diseases have in common that the human immune system attacks and damages the body's own structures.

The most important diseases are listed below with a brief explanation:

Bechterew's disease: Bechterew's disease is a chronic inflammatory, rheumatic disease that is accompanied by stiffness of the joints and pain. The spine in particular is affected. A typical manifestation of ankylosing spondylitis outside the joints is inflammation of the iris or inflammation of the anterior parts of the uvea (anterior uveitis). Mostly this occurs on one side. In addition, there is increased tear production and photophobia. The iritis can be accompanied by cataracts or glaucoma.
Rheumatoid arthritis: Rheumatoid arthritis is also a chronic inflammatory rheumatic disease of the joints. Mostly the fingers are affected here. This can be accompanied by iritis, which is accompanied by severe reddening of the eyes and reduced vision.
Inflammatory bowel disease: Inflammatory bowel diseases include Crohn's disease and ulcerative colitis. Apart from the inflammatory changes in the digestive tract (Gastrointestinal tract) there are also extraintestinal symptoms, which include inflammatory complaints of the eyes. In addition to isolated iritis, uveitis and keratitis (Corneal inflammation) can also have episcleritis (Inflammation of the dermis) occur.
Sarcoid (Boeck's disease): Sarcoid is an autoimmune disease granulomatous Disease that can in principle affect any organ system. Here too, the iris can be affected by inflammatory processes.
Scleroderma: Scleroderma is a skin disorder that is associated with the Collagenoses heard. The latter is a group of autoimmune connective tissue diseases. Inflammation of the iris can also occur here.
Other autoimmune diseases: Other diseases such as multiple sclerosis, Behçet's disease, etc. can also manifest on the iris and uvea.

Iritis with inflammatory genesis

This group of the Iritides lie Infectious diseases underlying. The body's immune response to the previous infection then leads to inflammation in the iris and uvea. So it is not a direct eye infection. Rather, the inflammation of the iris is that Result of the immune response for germs that are completely elsewhere in the body. Therefore, no germs can be detected there even with smears from the eyes.

The infection goes with the iritis with some degree time interval ahead.

The following is an overview of common underlying infectious diseases:

Chlamydia: This bacteria are found mainly in the human urogenital tract (the urinary and sexual tract) and in Germany are mainly through Transmit sexual intercourse. You can then get infections of the genitourinary tract, and eyes as a result of the infections reactive arthritis cause. The latter are Immune responses of the body, which can arise after an infection. The iris can also be affected.
Yersinia / Shigella / Campylobacter / Salmonella / Gonococci and others: Some of these pathogens affect the Gastrointestinal tract, other the Genitourinary tract. What they have in common is that they have the so-called secondary disease Reiter's disease can lead to. This is a A special form of reactive arthritiswhich can also be regarded as an immunologically caused phenomenon. Typically, Reiter's disease is through three Inflammation marked. This includes the Urethritis (Urinary tract infection), arthritis (Inflammation of the joints) and Conjunctivitis (Conjunctivitis) or just Iritis (Inflammation of the iris).
Other pathogens: Other pathogens and infections can also cause iritis. This includes flu- and Herpes viruses, tuberculosis, Glandular Pfeiffer fever, Lyme-Lyme disease, Toxoplasma and similar.

Symptoms

At a Inflammation of the iris are the Eyes reddened, very sensitive to light and can pain. There is also one Visual impairment. A Clouding of the eye results from an infiltration of the anterior chamber with inflammatory secretions and pus.

course

Of the Course of an iritis can acute or chronic be. Chronic courses and acute relapses that occur in An autoimmune disease occur are also more likely to occur Complications afflicted. If the Ciliary body is affected is called one Iridocyclitis.

Iritis complications

The inflammation leads to deterioration in vision.

Iritis can be certain Complications that can significantly reduce the quality of life of those affected.

First of all, this includes vitreous opacity. The transparency of the vitreous is reduced by infiltrates caused by the inflammation. This has a Reduced vision.

Furthermore, the inflammation can lead to a Change of the chamber angle to lead. This hinders the outflow of the so-called aqueous humor in the eye. As a result, there is one Pressure increase in the eye come that the Optic nerve damage. Such damage is then referred to as glaucoma (Secondary glaucoma). If left untreated, this can lead to Blindness to lead.

The final major complication is one connective tissue between the iris and lens to call. This is also known as Synechia. This gluing or adhesion can also be a Secondary glaucoma entail, but also to one Lens opacity (Cataract). The lens opacity also leads to one Visual impairment.

Diagnostics and examination

At first glance you can see one Redness of the eye as well as a Constriction of the pupil (Miosis). In addition, is the affected eye pressure painful (tender). To the Accumulation of pus in the anterior chamber (Hypopyon) ophthalmologists use the Slit lamp examination. This is a microscopic examination of the eye using a swiveling light source.

In addition, a regular measurement of intraocular pressure may be necessary to prevent dangerous complications.

As already mentioned, there are many different causes of iritis comprehensive laboratory tests (e.g. tests on different bacteria or Rheumatoid factors) necessary. Also imaging procedures can be used to e.g. Changes in joints to make visible in the context of rheumatic diseases.

therapy

The causal treatment of iritis can take different approaches as there are many different causes.

In general, the eye is first treated locally with ointments containing cortisone. Cortisone-free anti-inflammatory drugs, which can also be applied as ointments or drops, are also used here.

In addition, eye drops are used to dilate the pupil (Mydriatic). This is done to prevent the iris and lens from sticking, which could permanently damage the visual function.

If these local therapeutic approaches fail in a very severe course, systemic therapy with cortisone tablets and cortisone injections under the conjunctiva may be necessary.

If the cause of iritis is bacterial infection, antibiotic therapy is given.

However, since iritis is often no longer associated with the pathogen, but rather a consequence of the body's own immune response, antibiosis are not effective here. Therapy is then primarily directed against the inflammation and here too mostly uses anti-inflammatory drugs and cortisone preparations. There are various therapeutic approaches for autoimmune diseases that are specifically directed against the existing disease (e.g. rheumatism). The treating doctor then determines the therapy individually.

Read more on the topic: Eye ointment with cortisone