Primary angle-closure glaucoma - what is it? Posterior synechia of the eye

Normally, intraocular fluid flows freely from the posterior chamber of the eye to the anterior chamber through an opening in the iris - the pupil. In inflammatory diseases of the choroid, circular adhesions develop between the iris and the lens or vitreous body.

As a result, fluid cannot enter the anterior chamber. The accumulation of fluid leads to an increase in intraocular pressure in the posterior chamber. The iris protrudes into the anterior chamber. This condition of the iris is called iris bombardment.

Causes of iris bombing

Inflammatory diseases of the choroid of the eye

During inflammation, fibrin and protein compounds are produced inside the eye. This stimulates the formation of adhesions between the iris and the lens or vitreous.

Tumors of the choroid

The presence of a tumor in the choroid of the eye activates a weak inflammatory process. This leads to the formation of adhesions between the internal structures of the eye.

eye injury

When should you urgently see a doctor?

Sudden and severe pain in the eye
Pain caused by blunt and penetrating trauma to the eyeball
Pain accompanied by loss of vision
The pain appeared during the treatment of inflammatory diseases of the eye

Iris bombing symptoms

Strong pain
Decreased vision
Eye redness
Blepharospasm
Photophobia (photophobia)
Tearing, eye irritation

How to Treat Iris Bombing

Iris bombing is a medical emergency. Therapeutic measures include:

1) decrease in intraocular pressure;
2) anti-inflammatory and resolving therapy;
3) the formation of an additional message between the posterior and anterior chambers of the eye through a surgical operation - iridectomy.

Laser iridectomy

The laser machine creates a small hole in the iris. This opening allows intraocular fluid to flow from the posterior chamber of the eye into the anterior chamber. Thus, the operation removes the pupillary block and normalizes the intraocular pressure.

Surgical iridectomy

The hole in the iris is formed intraoperatively with a special tool.

Prevention of iris bombing

In the event of inflammatory diseases and eye injuries, immediately seek qualified medical help. Proper treatment will prevent the adhesive process inside the eye and the development of bombing of the iris.

Or there is a complete infection of the pupil. As a result of these changes, bombardment of the iris develops, which is accompanied by its bulging anteriorly due to the development of an organic block and a sharp increase in pressure inside the eye. Such changes are observed on phakic and eyes.

Peripheral anterior synechiae are fusion of the iris with or trabecular meshwork. Their formation can prevent the flow of intraocular fluid into the trabecular meshwork or completely block this process. Quite often, they form as a result of uveitis, but patients with an anatomically narrow angle of the anterior chamber, or with a decrease in the angle due to bombardment of the iris, are more prone to developing synechiae.

Posterior synechia is manifested by the fusion of the dorsum of the iris and the anterior shell of the lens (real or artificial), or the surface in the absence of the latter. The likelihood of adhesion formation in uveitis depends on the severity of the disease, its type and duration. With repeated uveitis, the likelihood of developing posterior synechia is much higher, since pupil dilation is worse due to previously formed adhesions.

The term "pupillary block" means a violation of the movement of intraocular fluid through the pupil between the posterior and anterior chambers, which develops during the formation of posterior synechia. If adhesions affect the entire radius of the pupil and pupillary membranes, then a complete block develops, in which the exchange of fluid between the chambers becomes impossible. Due to the increase in intraocular fluid volume in the posterior chamber of the eye, bombardment of the iris occurs or a rapid increase in intraocular pressure with the development of a deflection of the iris into the region of the anterior chamber. Against the background of ongoing inflammation, the bombardment of the iris very quickly leads to the closure of the angle, since this creates favorable conditions for the formation of peripheral anterior synechia.
Sometimes with uveitis accompanied by a pupillary block, massive adhesions are formed between the iris and the anterior lens shell. In this case, only the peripheral region of the iris is deflected. At the same time, it becomes difficult to diagnose iris bombardment without use.

Diagnostics

Patients suspected of having iris bombardment should have a minimal examination. This includes:

1. Ophthalmic examination.
2. .
3. .
4. .

It is also necessary to perform a number of clinical tests:

1. Blood test for hemoglobin, platelets and leukocytes.
2. Glucometry (determination of sugar level).
3. Serological testing for syphilis.
4. Determination of antibodies to hepatitis B.
5. Standard urinalysis.

In the presence of concomitant diseases, it is also necessary to consult a therapist.

Treatment

With a diagnosed bombing of the iris, treatment can be both conservative and using surgical techniques.

Among the drugs used to treat this disease are:

All these medicines contribute to the normalization of intraocular pressure.

Among the surgical methods for the treatment of iris bombing, the following methods are used:

1. Peripheral or surgical, which is performed with a transparent cornea and mild inflammation of the eyeball.
2. Laser iridectomy, synechiotomy is performed on pseudophakic eyes;
3. Surgical synechiotomy is performed on phakic eyes.

When performing laser iridotomy, the communication between the chambers of the eye (anterior and posterior) is restored. Due to the fact that only the pupillary block is eliminated, this method is effective only in cases where at least 25% of the iridocorneal angle is open. This treatment method requires several large holes to be made and the patient to be monitored to make sure the holes are functioning properly.

Surgical iridectomy is used in cases where laser iridectomy is not possible for any reason.

To evaluate the effectiveness of the intervention, it is necessary to observe the patient for a week. If there are no signs of inflammation, and intraocular pressure has returned to normal, then the result can be considered satisfactory.

During surgery, damage to the lens is possible. A patient with bombardment of the iris is issued a sick leave for a period of 3-4 weeks. In the future, dispensary observation by an ophthalmologist is necessary.

As already mentioned, the cause of the bombing of the iris may be pathologies of the eye, requiring the participation of an ophthalmologist in the treatment. In this case, it is important to choose an eye clinic where you will really be helped, and not "swept aside" or will "pull" money without solving the problem. The following is a rating of specialized ophthalmological institutions where you can undergo examination and treatment if you have been diagnosed with iris bombardment.

And it can lead to irreversible negative consequences. Also, when bombing the iris, there is a violation of the outflow of fluid from the posterior chamber to the area of the trabecular meshwork, which is accompanied by intraocular hypertension.

With the secondary closure of the anterior chamber angle of the eyeball, the following structural changes occur:

Unions anterior and posterior in the peripheral zone (sinechia);

Diagnostics

If iris bombardment is suspected, several studies should be performed:

Standard ophthalmic examination;
Tonometry.

In addition to instrumental examination, several analyzes are performed in the laboratory:

Study of blood glucose levels;
Determination of immunoglobulins to hepatitis B;
Determination of the concentration of platelets, hemoglobin, leukocytes;
Serological tests for syphilis;
General urine analysis.

If the patient has any comorbidities, then it is advisable to consult a therapist or a specialized specialist.

Treatment

If the patient has confirmed iris bombardment, then the doctor may apply conservative or surgical treatment.

As a drug therapy can be used:

Diakarba tablets;
Drops of adrenaline and atropine, timolol, glucocorticoids
Solutions of mannitol, hypertonic solution (10%) sodium chloride or glucose (40%).

The purpose of these drugs is to normalize intraocular pressure.

If the doctor decides to perform a surgical intervention, then he can resort to the following methods:

1. (surgical or peripheral) is performed in case of preservation of the transparency of the corneal substance and not very pronounced inflammation.
2. Surgical synechiotomy is possible only if there is a lens in the eyeball (artificial or own).
3. Laser iridectomy and synechiotomy are performed with pseudophakic eyeball.

In the case of the appointment of laser iridotomy as a result of the intervention, the communication between the anterior and posterior chambers of the eyeball is restored. Since this operation is aimed solely at eliminating the pupil block, it is effective only when the iris-corneal angle is open (at least 25%). During the operation, several rather large holes are applied. Further observation of the patient is required to ensure the effectiveness of these holes.

Surgical iridectomy is performed when laser intervention is not possible.

To assess the effectiveness of the manipulation, the patient's performance should be monitored for at least a week. In the absence of any inflammation and stabilization of intraocular pressure, the result is considered positive.

It should be noted that during the operation there is a risk of damage to the lens. When carrying out an operation for bombing, the period of disability is at least 3-4 weeks. After that, you should be regularly observed by a polyclinic doctor.

If you have been diagnosed with such a serious disease as bombardment of the iris, then you should definitely contact an experienced specialist who knows what to do. Below is a list of organizations where each person can receive proper diagnosis and comprehensive treatment for iris bombardment.

The best eye clinics in Moscow

Below we give the TOP-3 ophthalmological clinics in Moscow, where you can undergo the diagnosis and treatment of iris bombing.

Iris bombing (iris bombe) is a condition that develops with uveitis, when the structure of the anterior chamber is disturbed in the eye, preventing the outflow of intraocular moisture from the posterior chamber into the trabecular meshwork. There is a bulging of the collar in the form of a roller into the anterior chamber.

Causes

With iridocyclitis, there is a risk of formation of adhesions of the pupillary edge and the lens, or the pupil is completely infected. These changes provoke the bombardment of the iris, which is characterized by its bulging anteriorly due to the development of an organic block, with a sharp increase in intraocular pressure. Such changes can be observed both in phakic and aphakic eyes:

Synechia (anterior and posterior).
Pupillary block - it is customary to call it a violation of the movement of intraocular fluid through the pupil between the anterior and posterior chambers, which develops as a result of the formation of posterior synechia. When adhesions affect the entire area of the pupil, as well as the pupillary membranes, they speak of a complete block, with the inability to exchange fluid between the chambers. Due to the increase in the volume of intraocular fluid in the posterior chamber, bombardment of the iris occurs, accompanied by a rapid increase in intraocular pressure and the development of a deflection of the iris into the anterior chamber. Against the background of inflammation, bombardment of the iris provokes an early closure of the angle, as it creates favorable conditions for the formation of peripheral anterior synechiae.

In some cases, with uveitis, which is accompanied by a pupillary block, massive adhesions of the iris and the anterior lens shell can form. In this case, there is a deflection of the peripheral region of the iris. Then, for the diagnosis of bombing of the iris, gonioscopy is mandatory.

Diagnostics consists in carrying out a standard ophthalmological examination - visometry, biomicroscopy, ophthalmoscopy and tonometry.

Additional clinical studies:

General blood analysis
Blood test for sugar
Serological studies
Determination of antibodies to hepatitis B
Analysis of urine

Treatment

Iris bombing involves conservative and surgical treatment, which depends on the severity of the condition.

Therapeutic treatment. Apply means contributing to the normalization of intraocular pressure. Orally appoint Diakarb.

Intravenous drip:

Mannitol
40% glucose,
10% sodium chloride.
Topical agents (eye drops): adrenaline with atropine, timolol, glucocorticosteroids.

Surgery.

Peripheral iridectomy, performed with a transparent cornea, when the inflammation of the eyeball has a slight severity.
Laser iridectomy (sinechiotomy), which is performed with pseudophakic eyes;
Surgical synechiotomy performed on phakic eyes.

Performing laser iridotomy helps restore communication between the eye chambers (anterior and posterior). In this case, only the pupillary block is eliminated, which makes this method effective only in cases where more than 25% of the iridocorneal angle is open. During the operation, several large holes are made, which require long-term monitoring for their correct functioning.

Surgical iridectomy is used when it is impossible to perform laser. During the operation, damage to the lens is possible.

To evaluate the results of the intervention, the patient is subjected to a weekly dynamic observation. In the absence of signs of inflammation and normalization of intraocular pressure, the result is considered to be satisfactory.

The bombing of the iris is a violation of the structure of the anterior chamber of the eyeball. This condition often accompanies uveitis and can lead to irreversible negative consequences. Also, when bombing the iris, there is a violation of the outflow of fluid from the posterior chamber to the area of the trabecular meshwork, which is accompanied by intraocular hypertension.

With the secondary closure of the anterior chamber angle of the eyeball, the following structural changes occur:

- Unions anterior and posterior in the peripheral zone (synechia);

- Pupillary membranes, accompanied by the formation of a pupillary block and even displacement of the processes of the ciliary body into the anterior zone.

In the case of iridocyclitis, there is a high probability of formation of adhesions in the area of the pupillary edge and the lens. Sometimes there is a complete infection of the pupillary opening. As a result of the listed pathological processes, bombardment of the iris occurs. In this case, the latter bends anteriorly, as the intraocular pressure increases sharply due to the organic block. Such situations can occur in both aphakic and phakic eyeballs.

Anterior synechiae of the peripheral zone are formed when adhesions form between the cornea or trabecular meshwork and the iris. This disrupts the circulation of intraocular fluid from the posterior chamber to the trabecular zone. In some cases, the fluid flow becomes completely blocked. Adhesions in this area are often the result of inflammation in uveitis. However, patients with a narrow anterior chamber angle (anatomical feature or the result of iris bombardment) are more likely to form synechiae.

In posterior synechia, adhesions occur between the anterior lens membrane (the vitreous body in the absence of a lens lens) and the posterior part of the iris. At the same time, the tendency to form synechia is determined by the severity of the course of uveitis, its duration and type. In the case of recurrence of the disease, the risk of the formation of posterior adhesions increases significantly, due to the fact that the pupil expands worse due to previous synechia.

Pupillary block occurs when the circulation of intraocular fluid is disturbed due to impaired current from the posterior chamber to the anterior. This condition occurs during the formation of posterior synechia. With a complete block, we are talking about the defeat of the entire radius of the iris, as a result of which the flow of intraocular fluid from the posterior chamber to the anterior one becomes impossible. The result of this condition is a sharp increase in pressure in the region of the posterior chamber and an anterior deflection of the iris, or the formation of bombardment of the iris due to an increase in the volume of intraocular fluid. If the inflammatory process does not subside, then the bombardment of the iris leads to a rapid closure of the corner of the eye, since peripheral anterior synechia is easily formed in this case.

In some cases, with pupillary block against the background of uveitis, serious extensive adhesions of the iris to the anterior surface of the lens lens occur. Then only the peripheral zone of the iris bends under the influence of pressure. In this case, the diagnosis of iris bombing requires gonioscopy.

Diagnostics

If iris bombardment is suspected, several studies should be performed:

Visometry;
Standard ophthalmic examination;
biomicroscopy;
Tonometry.

In addition to instrumental examination, several analyzes are performed in the laboratory:

Study of blood glucose levels;
Determination of immunoglobulins to hepatitis B;
Determination of the concentration of platelets, hemoglobin, leukocytes;
Serological tests for syphilis;
General urine analysis.

If the patient has any comorbidities, then it is advisable to consult a therapist or a specialized specialist.

Treatment

If the patient has confirmed iris bombardment, then the doctor may apply conservative or surgical treatment.

As a drug therapy can be used:

Diakarba tablets;
Drops of adrenaline and atropine, timolol, glucocorticoids
Solutions of mannitol, hypertonic solution (10%) sodium chloride or glucose (40%).

The purpose of these drugs is to normalize intraocular pressure.

If the doctor decides to perform a surgical intervention, then he can resort to the following methods:

1. Iridectomy (surgical or peripheral) is performed in case of preservation of the transparency of the corneal substance and not very pronounced inflammation.
2. Surgical synechiotomy is possible only if there is a lens in the eyeball (artificial or own).
3. Laser iridectomy and synechiotomy are performed with pseudophakic eyeball.

Surgical iridectomy is performed when laser intervention is not possible.

The best eye clinics in Moscow

Below we give the TOP-3 ophthalmological clinics in Moscow, where you can undergo the diagnosis and treatment of iris bombing.

Clinic of Dr. Shilova T.Yu.

Moscow Eye Clinic

MNTK named after S.N. Fedorova

All eye clinics in Moscow >>>