The iris and ciliary body have the same blood and nerve supply. That
is, they are supplied by the same set of vessels and nerves. For this
reason it is practically impossible to have an iritis absolutely
independent of a cyclitis or some inflammation of the ciliary body. If
the iris is the primary seat of the trouble there are certain symptoms
that may indicate such a state. However, when we are treating the iris
or diagnosing conditions of the iris we must remember that the ciliary
body is very likely more or less involved and may be the primary seat
of the trouble.
In =iritis= there are some symptoms which are caused from the
hyperemic condition of the eye, such as a slight change in color. The
pupil becomes rather inactive, there is some ciliary injection with
photophobia, lacrymation and pain. In case of an exudate in the iris
there may be thickening, and the exudate in the anterior chamber of the
eye will form a =hypopyon=. Sometimes the small vessels will break and
there will be a little bleeding which will be mixed with the debris in
the bottom of the anterior chamber. This is known as hyphemia. There
are likely to be adhesions between the iris and the anterior capsule
of the lens known as posterior =synechia=. The pupil is more or less
irregular. If atropine is dropped into the eye to dilate the pupil,
parts of the edge of the pupil will be adhered while the other parts
dilate making it very irregular.
In case of cyclitis there is an exudate from the ciliary body into
the posterior chamber. This may cause a total adherence of the iris
to the crystalline lens. With the ophthalmoscope, opacities in the
vitreous may be noticed. These are exudates. The tension of the eye is
liable to increase a little at first but as the exudates absorb there
is more or less softening. Vision is low. Also in cyclitis there is
ciliary injection, photophobia, lacrymation and pain, similar to that
of iritis. Pressure on the eye ball will reveal a very tender condition
around the sclerocorneal junction or over the area of ciliary injection.
The causes of iritis, cyclitis or iridocyclitis frequently are systemic
conditions and infection such as syphilis, rheumatism, gonorrhea,
tuberculosis, infectious diseases and metabolic changes, it may be of
traumatic origin or sympathetic. Fuchs says “There are many cases of
iritis for which no cause can be discovered and therefore which cannot
be placed under these causes.” We agree with him and advance the theory
of cervical and upper dorsal lesions or trouble in the sinuses, nose,
nasopharynx or throat. No doubt osteopathy can throw some important
light on the causes of diseases of the iris and ciliary body. The nose
and throat should be examined in all these cases.
=Treatment.=—Atropine must be used in the sore eye to put the iris
and ciliary body at rest and dilate the pupil to draw it back from
the lens so that adhesions may not form. Warm compresses will give
much comfort. Sweating should be brought about. All fluid should be
reduced to a minimum. Diet should be very moderate and the bowels kept
unusually free. The eye should be protected by dark goggles. Thorough
treatment of the neck and upper dorsal region with attention to the
nose and throat should be given. Constitutional treatment should be
given according to the indications mentioned under causes. If annular
synechia or total posterior synechia form or there is atrophy of the
eyeball operative work may be needed. Also for injuries, tumors,
anomalies and so forth of the iris see the latest medical works on this
subject.