Fuchs heterochromic cyclitis

Fuchs' heterochromic cyclitis: Description, Causes and Risk Factors:Fuchs' heterochromic cyclitisA syndrome characterized by corneal degeneration, heterochromia of the iris, iridocyclitis, keratic precipitates, and cataract; probably autosomal dominant inheritance.Fuchs' heterochromic cyclitis (FHC) is an intraocular disease that usually strikes only one eye, causing a different iris color of the two eyes. This disease, which counts for 2-11% of all cases of anterior uveitis, shares the symptoms of a chronic, low-grade anterior uveitis with complications such as cataract, glaucoma, and vitreous opacities, but it does not show the typical symptoms of a cyclitis: pain, redness of the external eye, and miosis.During the last 100 years many different explanations for the pathomechanism of FHC have been proposed, but the etiology remained obscure. Increased levels of gamma globulins (including oligoclonal immunoglobulin G) in aqueous humor supported the hypothesis of an intraocular immune reaction. A recent publication concluded from the CD8-positive T cells in aqueous humor that FHC is an antigen-driven process.Many causes for FHC have been proposed. The increasing consensus that an immunologic reaction is involved in the pathologic process is consistent with the discovery of a rubella virus-driven antibody synthesis in the eye. Occasionally, Toxoplasma gondii has been discussed as a possible cause of FHC.Men and women are equally affected, and the disease tends to come to medical attention between the ages of 20 to 40.Progression of the disease is associated with cataract formation and glaucoma. Anti-inflammatory treatment is not indicated for the low-grade anterior chamber reaction seen in Fuchs' patients. Occasionally, a short course of corticosteroids is indicated if a symptomatic exacerbation occurs. The long-term prognosis is good, and patients usually maintain a visual acuity of 20/40 or better.Symptoms:Patients are usually asymptomatic but may present with floaters and blurry vision. There is a mild but persistent anterior chamber reaction with diffuse and characteristic white stellate keratic precipitates. Iris and trabecular meshwork show abnormal vessels that may sometimes lead to a hyphema (blood in the anterior chamber). Synechiae formation is uncommon.Heterochromia is considered an important feature.Diagnosis:The diagnosis is made on the basis of eye examination by an Eye specialist.Stromal and pigment epithelial atrophy of the iris leading to different colored irises.
  • Stellate deposits (keratic precipitates) over the entire corneal endothelium.
  • Mild anterior chamber cells which do not respond to steroid drops.
  • Mild vitreous cells.
  • No areas where the iris sticks to the lens (posterior synechiae).
  • Posterior subcapsular cataract.
  • Fine blood vessels (Amsler vessels) at the iris/corneal angle.
  • Lesions on the retina are found in 65% of patients.
Treatment:There is no direct treatment. Most ophthalmologists avoid long-term steroid eye drops in cases of Fuchs' heterochromic cyclitis as it responds poorly to the medication that in turn can give rise to Glaucoma &Cataract formation. Steroids are used in periods where the inflammation is giving symptoms that are significantly bothering the patient.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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