In this form there is no bulging. The iris is perfectly straight, though it may be pressed forward, with occlusion of the pupil. The anterior chamber is shallow. The iris is discolored, appearing of a dirty-red; its tissue is stretched, and large vessels are seen coursing across it. The tension is increased at first and later diminished. The vision is destroyed, and, when it is lost early in the disease, the choroid is probably the seat of the original inflammation, as when the disease commences in the iris the loss of vision does not come on as rapidly.
COURSE.-Irido-choroiditis is usually chronic in its course and the disease generally terminates in an atrophy of the eyeball. In rare cases it may, however, come to a standstill, the forms of the eye be saved and still more rarely some vision be restored.
CAUSES.-The most frequent causes are the adhesions between the iris and lens, which result in frequent recurring attacks of iritis with more and stronger adhesions until there becomes an occlusion of the pupil, and, if then another attack of iritis occurs, it will almost inevitably lead to an involvement of the ciliary body and choroid. Trousseau Soc. d’Opht de Paris, June 3, 1890. describes a peculiar form of iridochoroiditis with hypopyon recurring regularly a few days before the menses and disappearing in a few days. The condition lasted, for a long time, extending through the period of one pregnancy, ceasing with the menses during gestation and returning again after pregnancy. Similar cases were reported by others. Iridochoroiditis may also arise from injuries or wounds of the eye, as from foreign bodies, after operations, especially cataract extractions. It also is apt to occur as sympathetic ophthalmia in consequence of an injury to the other eye.
PROGNOSIS.-As a rule the prognosis in irido-choroiditis is unfavorable, but depends somewhat upon the extent of the intraocular changes. If seen early, before the vision and field of vision have become much impaired and there are but slight changes in the iris, it may be more favorable.
TREATMENT.-Our first object should be to prevent the disease, if possible, by properly treating every case of iritis, so that no posterior synechiae may remain to cause inflammation. In order to do this and also to prevent or break up adhesions which may tend to form between the iris and lens, Atropine should be energetically employed as early as possible and continued during the course of the disease, unless there is exclusion or occlusion of the pupil, where it will be of little service. Leplat plus Ann. de la Soc. med. chir., de Liege, 1889. reports several cases of irido-cyclitis in elderly people and cautions against the use of Atropine in such cases where the tension is increased, and claims better results are to be had from using Eserine, and, if necessary, puncture, combined with subcutaneous injections of Pilocarpine. If we have to deal with that form of irido-choroiditis in which the iris is bulged forward in knob- like protuberances, with complete adhesion of the pupillary edge of the iris to the lens, and iridectomy is indicated; but if it is the parenchymatous variety, with adhesion of the whole of the posterior surface of the iris to the lens, iridectomy will do more harm than good. If a foreign body should be the cause of the inflammation, it must be removed if possible, though when the injury in the ciliary region is very great, it is better to enucleate the eye in order to prevent trouble in the other. If the inflammation of the uveal tract is caused by sympathetic irritation from an injured eye-and this is the most common form of sympathetic ophthalmia-the injured eye, if sight is lost, should be removed upon the first symptoms of irritation or as early as possible, unless the inflammatory process is very severe, when it may be better to wait until it has subsided in some degree. If there is some sight in the injured eye, it is often difficult to decide whether enucleation is advisable or not. As a rule, an eye that has been lost from any cause and which remains painful, even if there are no symptoms of irritation in the healthy eye, should be removed. The irritation being probably transmitted by the ciliary nerves, division of these nerves (optico-ciliary neurotomy) has been recently proposed as a substitute for enucleation. It may be adapted to rare cases.
In old cases, in which the lens has become cataractous, it should be removed.
In the treatment of all forms of inflammation of the uveal tract complete rest of the eye for a long period must be insisted upon. In acute cases the patient should be confined to the house and treated as for iritis. In chronic cases it is better to allow moderate exercise in the open air, with the eyes protected by a bandage or colored glasses. The diet should be nutritious and generous, especially if the patient is feeble and ill-nourished.
The chief reliance must be placed upon internal medication, but for special indications refer to the therapeutics of iritis and choroiditis. The following remedies, however, have been more commonly used with advantage and would be among the first suggested to our minds : Rhus, Gelsemium, Kali iod., Bryonia, Mercurius cor., and iod., Belladonna, Silicea, Hepar., Apis., Arsenicum, Asafoetida, Aurum, Prunus spin., Sulphur, and Thuja.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.