Definition

Iridocyclitis is inflammation of the iris and ciliary body of the eye. It is part of a larger group of eye disease called uveitis, which is inflammation of the uvea (the inner layer of the eyeball between the retina and the sclera). Another name for iridocyclitis is anterior uveitis, which means uveitis in the eyeball anterior. Iridocyclitis is the most common type of uveitis, with 12 incidents per 100,000 people, accounting for around 50-70% of all uveitis cases.

Causes

Iridocyclitis can occur independently without being linked to disease or inflammation in other parts of the body. However, it can also be connected to a variety of other conditions, such as viral infections. One common viral infection associated with iridocyclitis is herpes simplex, which causes sores around the lips or genital areas. This form of iridocyclitis typically affects one eye and can present either as an acute or chronic condition. Another infection that may lead to iridocyclitis is tuberculosis, which is caused by bacteria called Mycobacterium tuberculosis. Unlike herpes simplex infections, iridocyclitis linked to tuberculosis tends to affect both eyes more frequently.

Furthermore, iridocyclitis can be linked to the presence of the HLA-B27 gene, which controls the HLA-B27 protein found on cell surfaces. Individuals with this gene may develop a range of diseases, including ankylosing spondylitis, inflammatory bowel disease, and psoriasis. Ankylosing spondylitis involves the inflammation of the spinal joints, which eventually causes stiffness in the spine. Inflammatory bowel disease, on the other hand, refers to the inflammation of the intestines, often presenting with symptoms like abdominal pain, weight loss, and diarrhea, which can be either bloody or non-bloody. Psoriasis is a condition that causes the skin to become inflamed, resulting in a red, scaly rash with a white, flaky appearance. Iridocyclitis linked to this gene tends to manifest in one eye suddenly and is typically acute (lasting less than three months).

In addition to the aforementioned causes, blunt trauma to the eye is responsible for about 20% of all iridocyclitis cases.

Risk Factor

The occurrence of iridocyclitis is consistent across all races and genders. While it can affect individuals of any age, it is most commonly seen in people between the ages of 40 and 50. Iridocyclitis linked to the presence of the HLA-B27 gene is more frequently observed in individuals with fair skin. In Indonesia, iridocyclitis is often caused by tuberculosis infections due to the high prevalence of tuberculosis in the region. Other risk factors for developing this condition include a history of autoimmune diseases, such as inflammation of the spinal joints, the presence of scaly rashes, or episodes of bloody diarrhea. External risk factors can also contribute to the development of iridocyclitis. These include physical trauma to the eye, insect bites, sexually transmitted infections like syphilis, parasitic infections such as toxoplasmosis, and viral infections including herpes simplex, herpes zoster, and rubella (German measles).

Symptoms

Symptoms of iridocyclitis can include dull ache of the eyes and itchiness near the eye, or a foreign body sensation in the eye. This pain occurs due to stiffness in the ciliary muscle, which adjusts the lens shape for focusing on near and distant objects. Other common symptoms are sensitivity to light, which exacerbates the pain due to inflamed iris muscles. Visual complaints can include decreased visual acuity and floaters, which are black dots floating in the vision. Visible symptoms in the eyes include redness. Typically, these symptoms appear for several days to three months (acute) but can last for more than three months (chronic).

Diagnosis

Diagnosing iridocyclitis involves reviewing the patient's medical history and identifying risk factors. The doctor will perform a visual function examination, which includes assessing visual acuity, eye movement, light reflex, and visual field to detect any disturbances. An examination of the outer eyes will be conducted to examine the pupil shape, which may change if the iris adheres to the lens—a condition that is not present under normal circumstances. The doctor may also check intraocular pressure, which can decrease if the ciliary body's fluid production is reduced.

A slit lamp examination can confirm iridocyclitis by revealing white blood cell buildup in the front center of the eyeball. An ophthalmoscope examination of the inside of the eyeball, after dilating the pupil, is also necessary to determine whether the inflammation is confined to the front of the eye (iridocyclitis) or extends to the middle or back of the eyeball.

Laboratory tests that can assist in diagnosing iridocyclitis include HLA-B27 gene examination and syphilis diagnosis tests, such as the treponema pallidum hemagglutination assay (TPHA) or venereal disease research laboratory (VDRL) test. If syphilis is confirmed, testing for other sexually transmitted diseases and HIV is necessary. A rapid molecular test (TCM) for tuberculosis can also be performed. If an autoimmune disease is suspected, an antinuclear antibody (ANA) test may be conducted. Urine tests can identify kidney issues, while imaging such as chest X-rays can help diagnose sarcoidosis or tuberculosis as the cause of iridocyclitis.

Management

The primary objective in managing iridocyclitis is to reduce inflammation. If the inflammation is infection-related, immediate treatment of the infection is necessary. For non-infectious inflammation, anti-inflammatory medications such as oral steroids may be prescribed. Other drugs that mitigate the inflammatory response can also be utilized. In severe cases, medication may be injected directly into the eye; however, this carries a risk of infection, and thus, the doctor will carefully consider the risks and benefits before proceeding. If an infection is the cause of inflammation, the treatment will be tailored to the specific infection. For instance, anti-tuberculosis drugs (OAT) are used for tuberculosis-related iridocyclitis.

Additionally, managing iridocyclitis involves pain relief. Cycloplegic drugs, which relax the muscles in the iris and ciliary body, are commonly used. These medications not only alleviate pain but also prevent the iris from adhering to the lens behind it.

Complications

A significant complication of iridocyclitis is the adhesion of the iris to the lens, which can obstruct fluid flow in the eye anterior, leading to increased intraocular pressure and glaucoma. Glaucoma itself can result in gradually diminishing vision and potential blindness. Cataracts can also develop as a complication, either from the inflammation itself or as a side effect of prolonged steroid use.

Prevention

Preventing iridocyclitis caused by the HLA-B27 gene is challenging. However, infection-related iridocyclitis can be prevented by avoiding the infections in question and adhering to proper treatment protocols to prevent the infection from spreading to the eyes. For example, individuals diagnosed with pulmonary tuberculosis should follow their doctor's advice and complete the full course of anti-tuberculosis drugs (OAT), even if symptoms subside. Similarly, practicing safe sex and avoiding multiple sexual partners can help prevent sexually transmitted infections like syphilis.

When to See a Doctor?

If you experience symptoms such as red eyes, eye discomfort, increased sensitivity to light that exacerbates pain, or decreased vision, it is crucial to consult a doctor immediately. These symptoms may indicate iridocyclitis or other conditions that require prompt treatment. Early intervention, preferably within 24 hours of symptom onset, can significantly improve the prognosis in cases of iridocyclitis.

Looking for more information about other diseases? Click here!