Uveitis is a form of eye inflammation that can cause significant discomfort and, if left untreated, may lead to serious complications including vision loss. One of the most important complications to understand is posterior synechiae, which occurs when the inflamed iris sticks to the lens inside the eye. At Insight Vision Optometry, Las Vegas, our team diagnoses and manages uveitis and its complications to help patients preserve their vision and comfort.
Anterior uveitis, also called iritis, is inflammation of the front part of the eye, primarily involving the iris and the ciliary body. The iris is the colored part of the eye that controls pupil size, and the ciliary body is the muscle behind the iris that helps with focusing.
Symptoms of anterior uveitis typically include:
Anterior uveitis can occur from infections, autoimmune conditions, or eye injuries, though in many cases the exact cause is not identified. If you experience sudden eye pain with light sensitivity and redness, this should be evaluated urgently by an eye doctor, as uveitis requires prompt treatment to prevent complications.
In severe cases of anterior uveitis, the inflammation can cause the iris to adhere to the crystalline lens directly behind it. These adhesions are called posterior synechiae. When the fluid inside the eye becomes inflamed, it becomes sticky, which allows the iris tissue to bond to the lens surface.
Posterior synechiae restrict the normal movement of the pupil, causing it to become fixed or irregularly shaped. While this creates short-term difficulties with focusing and light adjustment, the more serious risk is that the adhesions can block the normal drainage of fluid within the eye. When fluid cannot drain properly, pressure inside the eye can rise rapidly, potentially leading to a form of angle-closure glaucoma. This type of glaucoma can cause permanent vision loss if not treated quickly and is considered an eye emergency.
Treatment for posterior synechiae begins in the office and continues at home. The primary goal is to dilate the pupil to pull the iris away from the lens and break the adhesions.
In the office, your eye doctor will instill a dilating eye drop to enlarge the pupil. As the pupil expands, the synechiae are stretched and ideally pulled apart. If the adhesions break successfully, two types of eye drops are typically prescribed for use at home:
If the synechiae do not break completely with the initial dilation, your doctor may prescribe the dilating drop for continued use and re-evaluate the eye the following day to determine whether the adhesions have released.
Having a dilated pupil can cause light sensitivity and reduced near vision, but these side effects are temporary and far preferable to the risks of allowing the synechiae to persist.
Several dilating eye drops may be used to manage posterior synechiae. Homatropine is considered the standard treatment, though it can sometimes be difficult to obtain. Atropine is a longer-acting alternative that is also commonly used. In the office, cyclopentolate is often used initially because it acts quickly, and the patient can then fill a prescription for a longer-lasting drop to continue at home. Phenylephrine may also be used in some situations.
Regardless of which drop is prescribed, the goal is consistent: keep the pupil dilated to prevent the iris from adhering to the lens again while the inflammation is being controlled with steroid drops.
Uveitis symptoms, particularly sudden eye pain, redness, light sensitivity, and blurred vision, should always be evaluated promptly. Delaying treatment increases the risk of complications like posterior synechiae and secondary glaucoma. If you have a history of uveitis, be aware that recurrences are common, and contact your eye doctor at the first sign of a flare-up.
If you are experiencing symptoms of eye inflammation or have been previously diagnosed with uveitis, contact Insight Vision Optometry, Las Vegas at 702-747-4070 or visit www.insightvisionlv.com to schedule an evaluation with our team.
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