|Year : 1977 | Volume
| Issue : 3 | Page : 36
IS Jain, RL Koul, VP Munjal, GC Jain
Department of Ophthalmology Postgraduate Institute of Medical Education and Research, Chandigarh, India
I S Jain
Department of Ophthalmology Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Koul R L, Munjal V P, Jain G C. Miotic iridocyclitis. Indian J Ophthalmol 1977;25:36
Abraham considered that cases of glaucoma who are on prolonged miotic therepy and if miotics are not stopped a few days prior to glaucoma surgery are prone to get post-operative iridocyclitis in the form of posterior synechia, iris atrophy and pigmentary deposition on lens. However, weaker miotics like pilocarpine causing iridocyclitis before surgery, are not reported in the literature. The following case report is of great interest, as the clinical picture simulated granulomatous iridocyclitis, which promptly regressed on stoppage of pilocarpine.
| Case Report|| |
The patient, 60 years old female reported to Eye OPD of Nehru Hospital attached to Postgraduate Institute of Medical Education and Research, Chandigarh, in July, 1975, when she was diagnosed as a case of narrow angle glaucoma both eyes with mature cataract right eye. In the right eye iridectomy followed by cataract extraction was done. Post operative period was uneventful. In the left eye patient was advised to undergo peripheral iridectomy. As the patient was reluctant for surgery, she was put on 1% pilocarpine twice daily which she was using regularly since 24th October, 1975. After about 13 months the patient was willing for surgery and was admitted for complete iridectomy in this eye. On assessment prior to surgery her left eye showed white large KP's, no flare, few fine posterior synechia with pigment dispersion on anterior surface of lens. Pilocarpine was stopped and she was put on betnesol drops, and 10% phenylephrine drops, twice daily in this eye. After two days, KP's had disappeared and only some pigment could be seen on back of cornea. There was again no flare but pigment dispersion on anterior surface of lens and one posterior synechia was present at 7'0 clock.
Patient was diagnosed as a case of miotic iridocyclitis in view of such quick response to stoppage of pilocarpine and a few instillation of betnesol to which a granulomatous iridocyclitis would not have responded so quickly. However, she was investigated for uveitis and all investigations were normal. Patient had a complete iridectomy done in this eye. There was no post operative complication.
| Discussion|| |
With long acting miotics KP's, flare, partial detachments of uveal pigment layers and cysts have been reported by Gorin and Leopold.
The present case is unusual in the sense that an iritis with mutton fat KP's was induced even with a mild miotic like 1 % pilocarpine. It is worthwhile, for patients who are on miotic therapy to be assessed for any mild iritis prior to surgery.
| Summary|| |
A case of a 60 years old female who was on 1% pilocarpine drops for narrow angle glaucoma for a period of 13 months showed mutton fat KP's, posterior synechia and pigment dispersion on lens, which promptly resolved on stoppage of pilocarpine and topical betnesol drops. Iritis in glaucoma subjects, due to miotic therapy should always be kept in mind while investigating such patients.
| References|| |
Abraham, S.V. 1959, Amer. Jour. Ophth. 48,
Gorin, G., Einstein, A., 1972. Isreal Jour. Of Medi. Sci.,
Leopold, I. H. 1968. Amer. Juor. Ophth., 65.