Uveitis of the eyes - what kind of disease it is, photos, causes, symptoms and treatment. Uveitis (inflammation of the choroid of the eye): causes, forms, signs, treatment Uveitis inflammation of the choroid

The most common cause of uveitis is infection. Inflammation develops due to the penetration of streptococci, toxoplasma, mycobacterium tuberculosis, treponema pallidum, herpes viruses, cytomegalovirus, and fungi into the choroid. Pathogenic microbes get there from foci of chronic infection in the body.

Other causes of uveitis:

• reaction to taking certain medications;
• administration of vaccines or serums;
• allergic reaction to external irritants;
• hormonal disorders (diabetes mellitus, menopause);
• eye diseases (keratitis, blepharitis, corneal ulcer);
• systemic autoimmune diseases (rheumatoid arthritis, sarcoidosis, glomerulonephritis, rheumatism, colitis, autoimmune thyroiditis, Crohn's disease, etc.).

Uveitis can occur after injuries, contusions, chemical or thermal burns, or foreign bodies entering the eye. In this case, the cause of the development of the inflammatory process is the introduction of infection from the external environment.

Classification

Uveitis can be acute, chronic and chronic recurrent. The first develops very quickly, over several days or even hours. Usually it causes a lot of suffering to the patient. Fortunately, acute uveitis is easy to diagnose and responds well to treatment. With adequate and timely treatment, the disease goes away without any consequences.

Chronic uveitis has a sluggish course with scant symptoms. A person may suffer from the disease for many years. Such uveitis often recurs, that is, it worsens. During a relapse, the patient develops severe symptoms of the disease.

Depending on the location, there are:

• Anterior uveitis (iridocyclitis). Affects the iris and ciliary body of the eye. Iridocyclitis is characterized by pathological immobility of the pupil, changes in the color of the iris, and the appearance of precipitates on the inner surface of the cornea. All these signs can be identified by an ophthalmologist during an examination of the patient.
• Posterior uveitis (choroiditis). Characterized by inflammation of the posterior portion of the choroid. The pathological process involves the choroid, which lines the cavity of the eyeball from the inside. In this case, signs of inflammation can only be seen by ophthalmoscopy.
• Peripheral uveitis. It affects the flat part of the ciliary body and the peripheral part of the choroid along with the adjacent retina. Pathology is rare, only in 8-10%. The inflammatory process usually affects both eyes. The difficulty in diagnosing the disease lies in the fact that it is very difficult for a doctor to identify pathological foci. He cannot see them during biomicroscopy and ophthalmoscopy.

Depending on the cause and mechanism of development of uveitis, they are divided into exogenous and endogenous. The former occur under the influence of environmental factors (trauma, infections, burns). The latter are the result of chronic diseases (tuberculosis, syphilis, rheumatoid arthritis, etc.).

Symptoms

The severity of uveitis symptoms directly depends on the activity of inflammatory processes. The acute form of the disease has a clear clinical picture, which allows it to be quickly diagnosed. But chronic, indolent uveitis can be practically asymptomatic for a long time.

Signs of anterior uveitis:

• severe pain and cutting;
• feeling of a foreign body in the eye;
• intolerance to bright light;
• lacrimation;
• redness of the eye;
• decreased visual acuity;
• the appearance of a veil before the eyes;
• lack of pupil reaction to light.

Posterior uveitis, unlike anterior uveitis, does not cause pain. This is explained by the fact that the choroid is completely devoid of sensory nerve endings. Due to the lack of painful sensations, a person may not go to the hospital for a long time.

Symptoms of posterior uveitis:

• flickering flies in the field of view;
• light flashes before the eyes;
• color vision disturbance;
• distortion and decreased visual acuity.

It should be noted that chorioretinitis is rarely isolated. Usually, not only the vascular, but also the retina of the eye is involved in the inflammatory process. Consequently, the patient also develops symptoms indicating retinitis.

Which doctor treats uveitis?

An ophthalmologist is involved in the diagnosis and treatment of uveitis. If necessary, an immunologist, dermatovenerologist, phthisiatrician, allergist, infectious disease specialist or other specialist is involved in the treatment process.

Diagnostics

Pathology can be suspected by the presence of characteristic symptoms in a person. However, to confirm the diagnosis, a thorough examination by a doctor and a full examination are required. The patient may be tested not only in the ophthalmology clinic, but also referred for consultations to other specialists.

Methods for diagnosing uveitis

If necessary, the patient undergoes optical coherence tomography, angiography, electroretinography and rheoophthalmography. To clarify the cause of uveitis, you may need an x-ray of the lungs, a Mantoux test, allergy tests, CT or MRI of the brain, tests, etc.

Treatment

Treatment of ocular uveitis is carried out in an ophthalmological hospital, where the patient is required to be hospitalized. The treatment regimen is selected individually, taking into account the cause of inflammation.

The following drugs are used to treat uveitis:

• Corticosteroids (Dexamethasone, Betamethasone, Prednisolone). Steroid hormones are used topically. They are prescribed in the form of drops, subconjunctival, parabulbar and even intravitreal injections. Medicines have a powerful anti-inflammatory effect, thereby accelerating recovery.
• Midriatics (Atropine, Tropicamide, Cyclomed). The drugs in this group have the ability to dilate the pupil. They are prescribed to prevent the formation of posterior synechiae - adhesions between the iris and the anterior lens capsule. If the pupil has already become infected, mydriatics can help you cope with the problem.
• Broad-spectrum antibiotics (fluoroquinolones, cephalosporins, macrolides). Used for uveitis caused by bacterial infection. Antibacterial agents can be administered locally (injections) or systemically, in the form of tablets or intramuscular injections.
• Immunosuppressants (Methotrexate, Cyclosporine). They are used to treat autoimmune uveitis.
• Antiviral agents (Ophthalmoferon, Zovirax, Acyclovir). Used to combat uveitis of viral etiology. Kill the infection that caused the development of inflammation.
• Antihistamines (Suprastin, Claritin, Allergodil). Needed for uveitis of an allergic nature. Medicines inhibit the release of allergy mediators, thereby helping to get rid of inflammation and unpleasant symptoms.

The patient may also be prescribed vitamins, electro- or phonophoresis with proteolytic enzymes. In severe cases of the disease and the development of complications, the patient may need surgery (removal of adhesions, vitrectomy). Fortunately, the need for surgery is extremely rare.

Prevention

There is no specific prevention of uveitis. However, the development of the disease can be avoided through timely treatment of tuberculosis, syphilis, toxoplasmosis, rheumatoid arthritis and other systemic diseases.

If signs of acute uveitis appear, you should immediately consult a doctor. With adequate treatment, the disease will go away without any consequences within 3-6 weeks. If the necessary measures are not taken in time, the inflammatory process will become chronic. Naturally, dealing with chronic uveitis is much more difficult.

Uveitis is an inflammatory lesion of the choroid of the eye. The disease may be infectious, traumatic, allergic or autoimmune in nature. To treat uveitis, mydriatics, corticosteroids, antimicrobial and antiviral drugs are used. The treatment regimen is always selected on an individual basis.

Useful video about uveitis

Uveitis is a general term for an inflammatory disease of the choroid of the eyeball. Translated from Greek “uvea” means “grape”, since in appearance the choroid of the eye resembles a bunch of grapes.

Symptoms of uveitis

Diagnosis and treatment of uveitis

An ophthalmologist diagnoses and treats uveitis.

An ophthalmologist diagnoses and treats uveitis. To confirm the diagnosis, biomicroscopic examination of the anterior segment of the eye, ophthalmoscopy of the fundus and ultrasound scanning of the eye structures are used.
The difficulty of effective treatment of uveitis is due to the fact that even with the most thorough examination, in approximately 30% of cases the true cause cannot be identified. Therefore, pharmacotherapy for uveitis has a general pathogenetic focus and includes systemic and local anti-inflammatory, antibacterial, vasodilating, immunostimulating therapy, enzyme therapy, as well as physiotherapy. In all cases, local treatment is prescribed in the form of eye drops, ointments, injections under the conjunctiva and into the parabulbar space. It is especially important to use drops that dilate the pupil to avoid the formation of adhesions and adhesions. In some cases, medications are required to reduce increased intraocular pressure (drops, hirudotherapy).
This approach to treatment stops the inflammatory process, but does not guarantee the elimination of relapse (exacerbation) of uveitis. Therefore, in parallel with anti-inflammatory treatment, it is necessary, if possible, to examine the body as completely as possible.

Science is about the eyes: how to restore vigilance. Doctor's recommendations with exercises Igor Borisovich Medvedev

Diseases of the choroid

The choroid is located between the sclera and the retina. In appearance, the choroid resembles grapes, which is why it is also called uveal. Inflammatory diseases (iritis, iridocyclitis, endophthalmitis, panuveitis) most often develop in the choroid; dystrophic processes, tumors and injuries, as well as congenital anomalies are less common. Inflammatory diseases associated with the vascular system are called uveitis. The front part of the choroid is called the iris. The middle part is the ciliary body, and the back part is the choroid. So, let's try to remember:

Iritis - inflammation of the iris

Cyclit - inflammation of the ciliary body

Iridocyclitis - inflammation of the iris and ciliary body

Choroiditis– inflammation of the posterior part of the choroid

Chorioretinitis - inflammation of the choroid and retina

Panuveitis - inflammation of all parts of the choroid

Diseases are also divided into anterior uveitis And posterior uveitis.

Anterior uveitis manifests itself with acute symptoms. First, severe pain occurs in the eye, photophobia develops, the eyes turn red, tears flow, and vision loss may begin.

With posterior uveitis, the symptoms of the disease appear late and are mild. There is no pain or redness, but vision gradually decreases or a spot suddenly appears before the eyes, like fog or a veil.

Unfortunately, any uveitis is not just unpleasant, but also very dangerous. For example, the pupil may become overgrown, glaucoma, cataracts, retinal edema may develop, and new pathological vessels may form in the retina.

How to diagnose it? Clinical studies are needed. For example, biomicroscopic examination of the anterior segment of the eye, ophthalmoscopy of the fundus. These important studies help make the correct diagnosis. In addition, additional research is necessary: ​​fluorography of the respiratory organs and blood tests for various infections and diseases.

How to treat?

When the true cause of uveitis is determined, treatment is carried out with antibiotics and anti-inflammatory drugs. This can be local treatment in the form of drops and injections. In this disease, it is necessary to carefully monitor intraocular pressure. If intraocular pressure rises, it is reduced with drops, and sometimes surgery is performed.

Treatment for uveitis must begin as early as possible, as this disease can lead to vision loss. Therefore, if even slight redness of the eye occurs, which does not go away within two or three days, immediately visit an ophthalmologist.

Iritis

This inflammation of the iris, just like uveitis, must be diagnosed at an early stage. As a rule, this happens, since the iris is open and it is not difficult to examine it. But cyclitis - inflammation of the ciliary body - is hidden inside, so direct inspection of it is almost impossible. But most often, these two diseases occur simultaneously, and when doctors see iritis on the iris, they automatically treat cyclitis as well.

These diseases occur unexpectedly and acutely. The pupil becomes narrow, does not respond to light and does not dilate. The vessels in the iris immediately fill with blood, the iris itself swells and even changes color. We remember that when healthy it has a gray or bluish tint, while when inflamed it becomes green. With iritis, adhesions of the iris and the anterior lens capsule often occur. With insufficient treatment, the iris may become fused to the lens along the entire edge, which can lead to fusion of the pupil. The internal fluid that accumulates will begin to protrude the iris forward. As a result, intraocular pressure increases, hypertension develops, and in advanced cases, glaucoma.

Causes of the disease

They are varied. Ophthalmologists are not always able to quickly and accurately make a diagnosis, since it is impossible to take a piece of eye tissue for biopsy and histology. But it is known for sure that 60% of iridocyclitis occurs independently. And 40% reveals a connection with other diseases, usually of an infectious nature.

The vascular tract of the eye is designed in such a way that many viruses, fungi and bacteria settle on it. For example, antibodies to the herpes simplex virus are found in 80–90% of the adult population in the blood, but the infection manifests itself only under certain conditions: weak immunity, injuries, colds. It’s the same with inflammatory processes in the eyes - the infection can “dormant” for a long time, and then something will push it to actively “awaken”. Thus, iridocyclitis can be caused by an infection transmitted through the blood from various foci, where it could remain in a passive state for a long time.

Less commonly, iridocyclitis is associated with viral infection, tuberculosis, chlamydia, syphilis and rheumatoid arthritis.

It must be treated immediately! The sooner (in the first hours) the patient receives emergency care, the fewer complications and chances of developing a chronic form.

How to treat? First, you need to dilate the pupil using drops or local injections. It is also necessary to use anti-inflammatory drugs in the form of drops and tablets. Do not use traditional medicine under any circumstances - they will not help, but, on the contrary, can cause irreparable harm. Treatment of iridocyclitis is a complex and multicomponent process. It is aimed not only at treating the eye, but also at eliminating the inflammatory process in the body as a whole.

Choroiditis

This is a disease that occurs in the third part of the vascular tract - the choroid itself. With choroiditis, vision may decrease, but more often spots appear that interfere with viewing objects, vision is impaired in twilight lighting, and the shape of objects may be distorted.

The causes and principles of treatment for this disease are the same as for iridocyclitis.

Endophthalmitis This is an extremely dangerous purulent inflammation of the inner membranes of the eye with the formation of an abscess in the vitreous body. Endophthalmitis is accompanied by severe pain in the eye, pronounced swelling of the eyelids and redness of the eye. With this disease, an urgent operation is necessary (vitrectomy - removal of the vitreous body), and sometimes the count is not even days, but hours.

Panophthalmitis Occurs when a foreign body enters the eye or becomes infected. The disease is characterized by severe headaches, swelling of the eyelids and conjunctiva. The iris is severely irritated, and pus accumulates behind the lens. Urgent surgery and high doses of antibacterial drugs can stop the disease. But they must be used in the first days, as soon as symptoms of the disease are detected. Treatment is carried out in a hospital, under the constant supervision of a doctor. The disease can lead to vision loss and atrophy (shrinkage) of the eyeball.

Malignant neoplasms They can also develop in the vascular tract of the eye. It happens that dark spots appear on the iris - nevi. If you notice them, you should immediately consult a doctor.

Glaucoma

Intraocular pressure is created by the pressure of eye tissue and intraocular fluid on the wall of the eyeball. Normal intraocular pressure ranges from 18 to 26 mmHg. Art. Only in this range of intraocular pressure is the correct shape of the eyeball maintained and optimal conditions are provided for the circulation of fluid inside the eye, as well as nutrition of the optic nerve. Intraocular pressure depends on a number of reasons, but the most important of them is the normal amount of intraocular fluid and blood in the internal vessels. When the balance is disrupted, intraocular pressure rises. If it goes off scale, the optic nerve is compressed, its blood supply is disrupted, which leads to irreversible loss of vision. It happens that vision deteriorates only temporarily - during an exacerbation.

When the pressure is elevated, corneal edema often occurs. The swelling goes away and vision is restored. But if the optic nerve is damaged, vision may not be restored. This is how a disease called glaucoma.

According to world statistics, 23% of blind people suffered from glaucoma. Most often it develops after 40 years.

Glaucoma is translated from Greek as “green.” The fact is that when the disease worsens, the pupil becomes greenish.

Symptoms that can help you determine that you have glaucoma:

Increased intraocular pressure

Decreased vision

Fundus changes

There are two types of glaucoma - primary and secondary. The primary cause of the increase in intraocular pressure is not known. And with the secondary one, it is clear (blood in the anterior chamber, adhesions, etc.). Glaucoma can be closed-angle or open-angle. With angle closure, the eye may suddenly become sore and nausea may appear. The eye turns red and vision is blurred. And if you look at the light (lamp, sun), then multi-colored circles appear before your eyes. This means that intraocular pressure has increased. In this case, you must immediately go to an ophthalmologist, otherwise you may lose your vision forever.

Open-angle glaucoma, unlike closed-angle glaucoma, is insidious and unpredictable. It proceeds slowly and unnoticed. Nothing was foreshadowed, but suddenly, after an ordinary speck gets into your eye, you close your eyes, open them and... see nothing! It turns out that this eye has long been affected by open-angle glaucoma and has practically become blind. And all it took was a small push, after which the vision completely disappeared.

We must remember that with glaucoma, both eyes suffer. Only one of them is involved in the process first, and the second “joins” after a few years.

Glaucoma is an insidious disease. It disguises itself as various diseases, and sometimes it recedes altogether, allowing a person to think that he has recovered. Unfortunately, there is no complete cure for glaucoma.

Causes of glaucoma There are many of them, and there is no consensus on which one is the most basic. The fact is that eye pressure increases for various reasons - diabetes, hypertension. In 40% of cases, glaucoma occurs in people suffering from hypertension and certain diseases of the central nervous system. It is often inherited. Therefore, people over 40 years of age are recommended to measure intraocular pressure regularly, once a year. This is especially true for those whose relatives suffered from this disease.

How to treat?

The first thing to do is reduce the pressure. For this purpose, drugs are used that reduce the formation of fluid in the eye or improve its outflow. Drugs that improve metabolism in nervous tissue, antioxidants, and vitamin therapy are also prescribed.

Since glaucoma is a chronic disease, treatment and monitoring are required throughout life. Medicines carefully selected by a doctor - drops that reduce intraocular pressure - should always be at hand. It must be remembered that without them you can lose your eye forever. If treatment with drops is not enough, then surgical or laser treatment is added to the treatment.

Cataract

It occurs when the lens becomes cloudy. Recall that the lens is a biological optical lens that is located inside the eye behind the iris. It hangs on numerous thin threads to the ciliary muscle, which is shaped like a ring.

The lens receives everything it needs for its existence from the intraocular fluid surrounding it. Therefore, any changes that occur in the intraocular fluid are immediately reflected in the condition of the lens. It reacts to any metabolic disorder in the same way - it becomes cloudy.

Causes of cataracts

It most often occurs as a process of aging of the eye, but it can also be a complication of certain diseases, for example, diabetes mellitus, hypertension and other eye diseases - glaucoma, malignant myopia, iridocyclitis. Cataracts can develop as a result of exposure to certain chemicals: naphthalene, thallium, dinitrophenol, mercury, trinitrotoluene. But you shouldn’t think that using mothballs at home to repel butterflies can cause you to get cataracts. We are talking about high doses or their long-term use. In addition, cataracts are associated with harmful working conditions - in X-ray rooms, in glass blowing production. Clouding of the lens can also develop when it is exposed to ionizing radiation, infrared rays, or ultra-high frequency electromagnetic waves. Such diseases can be observed in steelworkers, radar station workers, and people exposed to radiation. Cataracts often occur as a result of injury, bruise, or damage to the lens by a foreign body.

Cataracts block the path of light rays. But due to illness, he loses his transparency and becomes a real obstacle for them. It is always accompanied by deterioration of vision. If cataracts progress throughout life, vision may disappear completely.

Cataracts have four stages of development:

Primary cataract - vision is still preserved, but patients complain of spots and “floaters” in front of the eyes.

Immature cataract– cloudiness covering a significant part of the lens, visual acuity sharply decreases.

Mature cataract– complete clouding of the lens, there is practically no vision anymore, patients can distinguish individual objects at arm’s length.

How to treat?

As in many other cases, first of all it is necessary to treat not the disease, but the reason why it arose. For example, diabetes. But in parallel with this, drops are prescribed that nourish the diseased lens. Unfortunately, there are cases when drops alone cannot help the lens - you have to remove it.

The technique of cataract surgery has been refined over hundreds of years. For many years we have been learning how to remove cataracts using various special techniques. Today, operations on the eyeball are performed using microsurgery. Operating microscopes, needles and suture material for suturing postoperative wounds were developed. And now methods have also been mastered in which, with the help of ultrasound, the lens is turned into an emulsion and sucked out through a small incision with a special apparatus.

Without a lens at all, the eye will not function normally because light rays will not be focused on the retina. However, in recent years it has become possible to replace a clouded lens with an artificial one. Even the optical power of each artificial lens is selected individually.

author Sergei Nikolaevich Basinsky

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Uveitis(wrong uevitis) - inflammatory pathology of various parts of the uveal tract (choroid), manifested by pain in the eyes, hypersensitivity to light, blurred vision, chronic lacrimation. The term "uvea" translated from ancient Greek means "grape". The choroid has a complex structure and is located between the sclera and the retina, resembling a bunch of grapes in appearance.

The structure of the uveal membrane has three sections: the iris, the ciliary body and the choroid, located under the retina and lining it outside.

The choroid performs a number of important functions in the human body:

The most basic and vital function of the uveal membrane for the body is to supply the eyes with blood. The anterior and posterior short and long ciliary arteries provide blood flow to various structures of the visual analyzer. All three parts of the eye are supplied with blood from different sources and are affected separately.

The parts of the choroid are also innervated differently. The branching of the vascular network of the eye and slow blood flow are factors that contribute to the retention of microbes and the development of pathology. These anatomical and physiological features influence the occurrence of uveitis and ensure their high prevalence.

With dysfunction of the choroid, the functioning of the visual analyzer is disrupted. Inflammatory diseases of the uveal tract account for about 50% of all eye pathologies. Approximately 30% of uveitis lead to a sharp drop in visual acuity or its complete loss. Men suffer from uveitis more often than women.

variety of forms and manifestations of eye lesions

Main morphological forms of pathology:

1. Anterior uveitis is more common than others. They are represented by the following nosologies - iritis, cyclitis,.
2. Posterior uveitis – choroiditis.
3. Median uveitis.
4. Peripheral uveitis.
5. Diffuse uveitis - damage to all parts of the uveal tract. The generalized form of the pathology is called iridocyclochoroiditis or panuveitis.

Treatment of uveitis is etiological, consisting of the use of local dosage forms in the form of eye ointments, drops, injections and systemic drug therapy. If patients with uveitis do not promptly consult an ophthalmologist and do not undergo adequate therapy, they develop severe complications: cataracts, secondary glaucoma, swelling and detachment of the retina, accretion of the lens to the pupil.

Uveitis is a disease, the outcome of which directly depends on the time of detection and consultation with a doctor. In order not to lead the pathology to loss of vision, treatment should be started as early as possible. If the redness of the eye does not go away for several days in a row, you should visit an ophthalmologist.

Etiology

The causes of uveitis are very diverse. Taking into account etiological factors, the following types of disease are distinguished:

In children and the elderly, ocular uveitis is usually infectious in nature. In this case, the provoking factors are often allergies and psychological stress.

Foci of inflammation in the uveal membrane are cotton wool-like infiltrates with fuzzy contours of yellow, gray or red color. After treatment and the disappearance of signs of inflammation, the lesions disappear without a trace or a scar is formed, visible through the sclera and looking like a white area with clear contours and vessels along the periphery.

Symptoms

The severity and variety of clinical symptoms in uveitis are determined by the localization of the pathological focus, the general resistance of the body and the virulence of the microbe.

Anterior uveitis

anterior uveitis has the most noticeable manifestations

Anterior uveitis is a unilateral disease that begins acutely and is accompanied by a change in the color of the iris. The main symptoms of the disease are: eye pain, photophobia, blurred vision, “fog” or “veil” before the eyes, hyperemia, excessive lacrimation, heaviness, pain and discomfort in the eyes, decreased sensitivity of the cornea. The pupil in this form of pathology is narrow, practically unresponsive to light and has an irregular shape. Precipitates are formed on the cornea, which are an accumulation of lymphocytes, plasma cells, and pigments floating in the chamber moisture. The acute process lasts on average 1.5-2 months. In autumn and winter the disease often recurs.

Anterior rheumatoid serous uveitis has a chronic course and a mild clinical picture. The disease is rare and is manifested by the formation of corneal precipitates, posterior adhesions of the iris, destruction of the ciliary body, and clouding of the lens. Rheumatoid uveitis has a long course, is difficult to treat and is often complicated by the development of secondary ocular pathology.

Peripheral uveitis

With peripheral uveitis, both eyes are often affected symmetrically, and “floaters” before the eyes, visual acuity deteriorates. This is the most diagnostically difficult form of pathology, since the focus of inflammation is located in an area that is difficult to study with standard ophthalmological methods. In children and young people, peripheral uveitis is especially severe.

Posterior uveitis

Posterior uveitis has mild symptoms that appear late and do not worsen the general condition of patients. In this case, there is no pain and hyperemia, vision decreases gradually, flickering dots appear before the eyes. The disease begins unnoticed: patients experience flashes and flickering before their eyes, the shape of objects is distorted, and vision becomes blurred. They experience difficulty reading, twilight vision deteriorates, and color vision is impaired. Cells are found in the vitreous humor, and white and yellow deposits are found on the retina. Posterior uveitis is complicated by macular ischemia, macular edema, retinal detachment, and retinal vasculitis.

The chronic course of any form of uveitis is characterized by the rare occurrence of mild symptoms. The patient's eyes become slightly red and floating spots appear before the eyes. In severe cases, complete blindness, glaucoma, cataracts, and inflammation of the eyeball membrane develop.

Iridocyclochoroiditis

Iridocyclochoroiditis is the most severe form of pathology, caused by inflammation of the entire vascular tract of the eye. The disease manifests itself with any combination of the symptoms described above. This is a rare and serious disease that is a consequence of hematogenous infection of the uveal tract, toxic damage or severe allergization of the body.

Diagnostics

Ophthalmologists diagnose and treat uveitis. They examine the eyes, check visual acuity, determine visual fields, and perform tonometry.

The main diagnostic methods to detect uveitis in patients:

1. Biomicroscopy,
2. Gonioscopy,
3. Ophthalmoscopy,
4. Ultrasound of the eye,
5. Fluorescein angiography of the retina,
6. Ultrasonography,
7. Rheoophthalmography,
8. Electroretinography,
9. Anterior chamber paracentesis,
10. Vitreal and chorioretinal biopsy.

Treatment

Treatment of uveitis is complex, consisting of the use of systemic and local antimicrobial, vasodilating, immunostimulating, desensitizing drugs, enzymes, physiotherapeutic methods, hirudotherapy, and traditional medicine. Patients are usually prescribed drugs in the following dosage forms: eye drops, ointments, injections.

Traditional treatment

Treatment of uveitis is aimed at the rapid resorption of inflammatory infiltrates, especially in cases of indolent processes. If you miss the first symptoms of the disease, not only the color of the iris will change, its degeneration will develop, and everything will end in disintegration.

For drug treatment of anterior and posterior uveitis, the following is used:

• Antibacterial agents broad spectrum of action from the group of macrolides, cephalosporins, fluoroquinolones. The drugs are administered subconjunctivally, intravenously, intramuscularly, intravitreally. The choice of drug depends on the type of pathogen. To do this, a microbiological examination of eye discharge is carried out for microflora and the sensitivity of the isolated microbe to antibiotics is determined.
• Viral uveitis is treated with antiviral drugs– “Acyclovir”, “Zovirax” in combination with “Cycloferon”, “Viferon”. They are prescribed for local use in the form of intravitreal injections, as well as for oral administration.
• Anti-inflammatory drugs from the group of NSAIDs, glucocorticoids, cytostatics. Patients are prescribed eye drops with prednisolone or dexamethasone, 2 drops into the affected eye every 4 hours - “Prenacid”, “Dexoftan”, “Dexapos”. Indomethacin, Ibuprofen, Movalis, Butadione are taken internally.
• Immunosuppressants prescribed when anti-inflammatory therapy is ineffective. Drugs in this group inhibit immune reactions - Cyclosporine, Methotrexate.
• To prevent the formation of adhesions, eye drops “Tropicamide”, “Cyclopentolate”, “Irifrin”, “Atropine” are used. Mydriatics relieve spasm of the ciliary muscle.
• Fibrinolytic drugs have a resolving effect - “Lidaza”, “Gemaza”, “Wobenzym”.
• Antihistamines means “Clemastin”, “Claritin”, “Suprastin”.
• Vitamin therapy.

Surgical treatment of uveitis is indicated in severe cases or in the presence of complications. The adhesions between the iris and the lens are surgically cut, the vitreous body, glaucoma, cataracts, and eyeball are removed, and the retina is soldered with a laser. The outcomes of such operations are not always favorable. An exacerbation of the inflammatory process is possible.

Physiotherapy is carried out after acute inflammatory phenomena have subsided. The most effective physiotherapeutic methods: electrophoresis, phonophoresis, vacuum pulsed eye massage, infitatherapy, ultraviolet irradiation or laser blood irradiation, laser coagulation, phototherapy, cryotherapy.

ethnoscience

The most effective and popular methods of traditional medicine that can complement the main treatment (in consultation with the doctor!):

Prevention of uveitis consists of maintaining eye hygiene, preventing general hypothermia, injuries, overwork, treating allergies and various pathologies of the body. Any eye disease should begin to be treated as early as possible so as not to provoke the development of more serious processes.

Video: mini-lecture on uveitis

Anatomy of the choroid

Vascular tract (uvea) consists of three sections: the iris ( iris), ciliary or ciliary body ( corpus ciliare) and the choroid itself ( chorioidea).

Iris– the anterior, visible part of the choroid has an extensive network of sensitive innervation from n. ophthalmicus(first branch of the trigeminal nerve). The vascular network of the iris is formed by the anterior ciliary and posterior long ciliary arteries. The iris is divided into anterior (mesodermal) and posterior (ectodermal) sections. The mesodermal layer consists of the outer boundary layer, which is covered with endothelium, and the stroma of the iris. The ectodermal layer consists of muscle, internal boundary and pigment layers. There are two muscles in the iris - the dilator and the pupillary sphincter. The first is innervated by the sympathetic nerve, the second by the oculomotor nerve. The color of the iris depends on its pigment layer and the presence of pigment cells in the stroma.

The function of the iris is to regulate the amount of light entering the retina by changing the size of the pupil, that is, the function of the diaphragm. It also, together with the lens, differentiates the anterior and posterior sections of the eye, and together with the ciliary body produces intraocular fluid. Through the pupil there is an outflow of aqueous humor from the posterior chamber to the anterior chamber.

Ciliary body not available for inspection. Its soreness is examined by palpation; with gonioscopy, a small area of ​​its surface is partially visible, passing into the root of the iris. The ciliary body is a ring about 6-7 mm wide. Its anterior part has about 70 processes, it is called the ciliary crown ( corona ciliaris). The back part is flat, called the ciliary circle, the flat part ( orbіculus cilіaris or pars plana). The ligaments of Zinn are attached to the lateral surfaces of the ciliary processes, which hold the lens.

As in the iris, in the ciliary body there is a mesodermal part, which consists of 4 layers (suprachoroid, muscular layer, vascular layer, basal lamina) and an ectodermal part, which is represented by two layers of epithelium: the outer pigmented and the inner non-pigmented.

In the thickness of the ciliary body there is an accommodative muscle, which has double innervation: parasympathetic ( n. oculomotorius) and sympathetic. Sensory innervation is carried out n. ophthalmicus.

The accommodative muscle consists of three parts: meridian (Brücke's muscle), circular (Müller's muscle) and radial (Ivanov's muscle).

There are many vessels in the ciliary body - branched anterior ciliary and posterior long ciliary arteries and veins of the same name.

Function of the ciliary body: accommodation and production of intraocular fluid.

Choroid- the posterior part of the vascular tract, lining the fundus of the eye, visible through the transparent retina. Consists of 5 layers: suprachoroidal, layer of large vessels, layer of medium vessels, choriocapillaris layer, basal lamina (vitreous membrane of Bruch). The choriocapillary layer is closely connected with the retinal pigment epithelium, therefore, in diseases of the choroid, the retina is involved in the process.

The blood supply to the choroid is carried out by the posterior short ciliary arteries, the outflow of blood occurs through the vorticose veins, which pass through the sclera at the equator. Has no sensory innervation. Function: retinal trophism.

Thus, the iris and ciliary body have a common blood supply and innervation, and therefore are usually affected simultaneously. The peculiarities of the blood supply to the choroid determine the isolation of its lesions. However, all three sections of the choroid are anatomically closely connected; there are anastomoses between the systems of the anterior and posterior ciliary vessels, so the pathological process can involve the entire uveal tract.

Diseases of the choroid

The following types of pathological conditions of the choroid are distinguished:

1) developmental anomalies;

2) inflammatory diseases (uveitis);

3) dystrophic diseases (uveopathy);

4) neoplasms.

Developmental anomalies

Albinism complete absence of pigment in the skin, hair, eyebrows, eyelashes. The iris is very light, visible through red light, sometimes the sclera is visible through. The fundus is light, the choroidal vessels are visible. Low vision, photophobia, and nystagmus are noted.

Treatment: correction of refractive errors, pleoptics.

Aniridia absence of iris. Complaints of low vision, photophobia.

Treatment: contact lenses, surgery - iridoprosthetics.

Polycoria the presence of several pupils. Complaints of low vision, monocular diplopia.

Correctopia change in pupil position .

Treatment: contact lenses, surgery - closed iridoplasty.

Coloboma of the iris defect of the iris, always located below, the pupillary border and sphincter of the pupil are preserved.

Treatment: surgery - closed iridoplasty, contact lenses.

Coloboma of the choroid localized in the lower part of the fundus of the eye, in this area the retina is underdeveloped or absent.

Treatments No.

Residual pupillary membrane in the area of ​​the pupil there are white opaque threads that start not from the edge of the pupil, but from the projection of the small arterial circle of the iris.

Treatment: removed only when vision decreases.

Inflammatory diseases of the vascular tract (uveitis)

There are anterior uveitis (iritis, cyclitis, iridocyclitis), posterior uveitis (choroiditis) and panuveitis, depending on which part of the vascular tract is affected.

Iridocyclitis. The inflammatory process in the anterior part of the vascular tract can begin from the iris (iritis) or from the ciliary body (cyclitis). But due to the common blood supply and innervation of these parts, the disease quickly moves from the iris to the ciliary body or vice versa, and iridocyclitis develops. There are acute and chronic forms of the disease. The patient complains of photophobia, lacrimation, eye pain and decreased vision.

Clinical signs:

- pericorneal or mixed injection;

- pain on palpation of the eye (ciliary pain) and decreased accommodation;

- swelling and hyperemia of the iris, heterochromia;

 the pupil is constricted, poorly responsive to light;

- posterior synechiae - fusion of the iris with the anterior surface of the lens;

- vitreous opacification;

- presence of precipitates on the corneal endothelium.

In severe cases, purulent exudate may appear in the anterior chamber of the eye (hypopyon) or blood (hyphema). After using mydriatics, the pupillary margin may acquire jagged contours as a result of the presence of posterior synechiae. If mydriatics are not used, a circular synechia may form, and then a film that can completely close the lumen of the pupil.

Complications. If posterior synechiae form along the entire pupillary edge of the iris, aqueous humor, which is secreted by the ciliary body, cannot enter the anterior chamber from the posterior chamber, and bombardment (protrusion into the anterior chamber) of the iris occurs. The root of the iris also moves forward, adhesions arise between the anterior surface of the iris and the posterior surface of the cornea (anterior synechiae), which block the angle of the anterior chamber, where the drainage zone of the eye is located. All this leads to increased intraocular pressure and the development of secondary glaucoma). In addition to secondary glaucoma, complications of anterior uveitis can be: band-shaped corneal degeneration, complicated uveal cataract, hypotony, eye subatrophy).

Differential diagnosis carried out with an acute attack of angle-closure glaucoma, acute conjunctivitis (Table 3).

Table 3. Differential diagnosis of acute iridocyclitis with an acute attack of glaucoma and acute conjunctivitis

Signs	Acute attack of glaucoma	Acute iridocyclitis	Acute conjunctivitis
Clinical course, complaints	Sudden onset, severe pain in the eye with irradiation to the temporal region, jaw; headache, nausea, vomiting	Gradual onset, constant aching pain in the eye, photophobia	Gradual onset, foreign body sensation under the eyelids
Visual acuity	Significantly reduced		Normal
Intraocular pressure		Normal or slightly reduced	Normal
Vascular injection	Stagnant	Pericorneal or mixed	Conjunctival
Cornea		Precipitates	Not changed
Anterior chamber of the eye		Normal depth	Normal depth
Reaction to light, pupil size	Absent, wide pupil	Decreased, pupil narrow	Saved, normal
	Sometimes swollen	The pattern is smoothed, swelling	Not changed

Choroiditis (posterior uveitis) - inflammation of the choroid itself, which is usually combined with inflammation of the retina and is called chorioretinitis.

Due to the lack of sensitive innervation, there are no complaints of pain in the eye, photophobia, or lacrimation in choroiditis that are characteristic of anterior uveitis. When examined, the eye is calm. Depending on the localization of the process, patient complaints vary. With central localization, closer to the posterior pole, patients complain of a significant decrease in visual acuity, flashes and blinking in front of the eye (photopsia), as well as metamorphopsia (curvature of objects and lines). These complaints indicate that the retina is involved in the process. Diagnosis is carried out using the ophthalmoscopy method. In the case of peripheral forms of inflammation, depending on the size of the lesions, patients may complain of photopsia and impaired twilight vision (hemeralopia), and in the presence of small and single lesions there are no functional subjective sensations. Inflammation can be focal (isolated) or disseminated. Fresh choroidal lesions are a yellowish-gray cellular infiltrate with unclear boundaries. The retina above the infiltrate is edematous, so the course of the vessels is not ophthalmoscopically visible in some places.

Opacification develops in the posterior parts of the vitreous, and sometimes precipitates are visible on the posterior limiting membrane of the vitreous.

As the inflammatory process subsides, the lesion acquires a whitish-gray color with clear boundaries. In the focal area, the stroma of the choroid atrophies, and a dark brown pigment appears at the site of infiltration. In the chronic course of the process, gray-green granulomas with prominence can sometimes form, which can be the cause of exudative retinal detachment. In this case, it is necessary to carry out a differential diagnosis with a choroidal neoplasm.

Etiology and pathogenesis of uveitis. The mechanisms of development of uveitis are predetermined by the action of infectious, toxic, allergic and autoimmune factors. Most often these are endogenous factors: infection from other foci of inflammation in the body, as well as in systemic diseases: collagenosis, especially juvenile rheumatoid arthritis, ankylosing spondylitis, Reiter's disease; tuberculosis, secondary syphilis, sarcoidosis, Behçet's disease (hypopyon-iridocyclitis, aphthous stomatitis, damage to the mucous membrane of the external genital organs), brucellosis, toxoplasmosis, herpes, etc. Exogenous factors also play a significant role in the etiology of iridocyclitis: the consequences of penetrating eye injuries, chemical burns, perforation of corneal ulcers, etc.

Treatment. In order to identify and sanitize possible foci of infection and other etiological factors, it is necessary to conduct a complete examination of the body. Cycloplegics and mydriatics are used for anterior uveitis to reduce pain and prevent the formation of posterior synechiae. Antibiotics, sulfa drugs, corticosteroids are prescribed locally, parabulbarly, intramuscularly, non-steroidal anti-inflammatory drugs, desensitizing drugs, immunomodulators. If an etiological factor is established, appropriate specific therapy is prescribed. Physiotherapeutic methods of treatment (magnetic therapy, laser irradiation, electrophoresis) must be used.