Segmental atrophy of the iris

Introduction Segmental atrophy of the iris: due to a certain high intraocular pressure state, the iris artery has a blood supply disorder, resulting in an ischemic segment or a fan-shaped atrophy consistent with the shape of the iris artery. Iris segmental atrophy is a clinical manifestation of remission in acute congestive glaucoma.

Cause

1 Anatomical factors: such as small cornea, small eyeball, often combined with hyperopia, shallow anterior chamber, narrow angle of the eye caused by elevated intraocular pressure.

2 vascular nerve factors: leading to vasomotor dysfunction, causing ciliary body edema, advancement and obstruction of the angle of the anterior chamber, as well as excessive secretion of aqueous humor, increased posterior pressure, so that the surrounding iris forward.

3 high pleated iris type patient: the iris root position is forward, when the pupil is obviously scattered, the accumulation of the surrounding iris is aggravated, and the contact with the trabecular surface obstructs the outflow of the aqueous humor, resulting in an increase in intraocular pressure. In addition to the above, emotional excitement: trauma, excessive fatigue, sudden changes in climate, overeating, etc., often lead to the cause of this disease.

an examination

Related inspection

Iris examination ophthalmoscopy

1 patients with severe eye pain and ipsilateral headache, rainbow vision, decreased vision, severe only left the index or light perception, often combined with nausea, vomiting, fever, chills and constipation, but also diarrhea.

2 signs: A. elevated intraocular pressure, generally in the 6.6-10.64kpa (50 ~ 80mmHg), up to 13.3 kpa (100mmHg) or more. Pressing the eyeball from the upper finger is as hard as a stone. B. The pupil is dilated. C. Mixed hyperemia. D. Corneal edema. E. The anterior chamber is shallow and the anterior chamber is occluded. F. The aqueous humor is turbid. G. Iris segmental atrophy. H. Glaucoma spots appear under the anterior capsule of the crystal.

3 clinical stage: A. preclinical and aura: no symptoms, but the anterior chamber is very shallow, glaucoma stimulation test positive, called preclinical. Small episodes before an acute attack have more incentives for each episode. There are often rainbow vision, eye pain, headache, nausea and other symptoms, after a full rest or sleep can alleviate the aura.

B. Acute attack: sharp increase in intraocular pressure, mixed hyperemia, corneal edema such as mist, shallow anterior chamber, enlarged pupil, occlusion of the anterior chamber, severe headache, eye swelling, severe vision loss or even blindness.

C. In the remission period, acute angle-closure glaucoma can be restored to the normal range after treatment or natural remission. Eye congestion of corneal edema subsides the health search center to restore visual acuity to pre-onset levels or slightly lower health search corners to reopen health search. These patients have different degrees of adhesion closure in the corners of the patient, and the trabecular mesh remains a large amount of pigment? Especially in the lower corners of the square, there are a small number of patients with pupillary sphincter paralysis or iris segmental atrophy to remove pupillary block. In addition, most patients can still stimulate the increase of intraocular pressure in acute test. The acute retinal glaucoma remission period is a temporary health search. In this period, peripheral iridotomy can relieve pupillary block and prevent re-acute episodes. Flat web.

D. Chronic phase: After an acute episode, without proper treatment, the intraocular pressure is moderately elevated, the angle of the anterior chamber is partially occluded, and the visual field and fundus damage are seen in the late stage.

E. Absolute period: sustained high intraocular pressure, leading to blindness.

Differential diagnosis

1. Axonal lesions, a forming change that causes the optic nerve to become thinner. It is a general term for pathology and generally occurs in the ganglion cell axis mutation between the retina and the lateral geniculate body.

2. One side of the nipple atrophy, the other side of the edema: the intrinsic tumor or abscess in the bottom of the frontal lobe of the brain, such as internal carotid aneurysm, olfactory sulcus meningioma, anterior cranial skull meningioma, craniopharyngioma and so on. Others such as the internal carotid artery fusiform expansion, internal carotid artery sclerosis, anterior cranial fossa trauma, anterior cranial arachnoiditis can also cause axillary nipple atrophy and edema on the other side. Since one side of the optic nerve is first atrophied by direct compression of the tumor, the intracranial pressure is increased due to the continued growth of the tumor, resulting in edema of the contralateral papilla.

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