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Disease
- Chronic, usually unilateral, non-granulomatous, low-grade anterior uveitis
- Typically occurs in the 3rd to 4th decade of life
- Equal occurrence in men and women
- Associated with rubella
Findings
- Corneal endothelial precipitates: small, round, or stellate, gray-white, distributed over the entire corneal endothelium, sometimes associated with feathery fibrin filaments
- Mild anterior chamber flare
- Diffuse iris atrophy (earliest finding: loss of iris crypts), small nodules at the pupil margin and stroma
- Iris heterochromia (80%): usually the affected eye is hypochromic (in blue eyes, the affected eye may be hyperchromic)
- No posterior synechiae; except after cataract surgery
- Fine iris/chamber angle neovascularisations (may bleed during cataract surgery), no peripheral anterior synechiae
- Vitritis
- Complications: Cataract (typically posterior subcapsular opacity), glaucoma
Treatment
- Often no therapy necessary due to low-grade inflammation and poor response to steroids
- Consider short-term local steroid therapy for moderate to severe inflammation
- No cycloplegia necessary (as there is no formation of posterior synechiae)
Sources
- EyeWiki Fuchs’ Heterochromic Iridocyclitis
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)