Fuchs heterochromic iridocyclitis is a chronic eye condition that causes inflammation in the uvea. Diagnosis is based on observation and examination, and three predispositions, including heterochromia, glaucoma or cataracts, and posterior vitreous detachment, can increase the likelihood of developing the condition. Treatment includes topical corticosteroids and nonsteroidal anti-inflammatory drugs, and surgical treatment is usually not possible. Glaucoma and cataracts require medical attention.
Fuchs heterochromic iridocyclitis (FHI) is also known as Fuchs heterochromic uveitis (FHU) or Fuchs heterochromic cyclitis (FHC). It is a chronic eye condition that typically occurs in only one eye, although it can affect both. With this condition, a part of the eye called the uvea becomes inflamed on a regular basis.
Diagnosing Fuchs heterochromic iridocyclitis is not done through laboratory tests. Laboratory work can be done to rule out other forms of uveitis, but doctors generally need to rely on observation and examination, as signs will usually be evident. Also, a thinning or flattening of the iris may be visible. A patient may also have inflammatory cells, called keratic precipitates, on the back of the cornea.
There are three predispositions that doctors look for when considering a patient’s chances of developing Fuchs heterochromic iridocyclitis. Heterochromia, which is when a person has two differently colored irises, is the main factor. A likelihood of developing glaucoma or cataracts is another predisposition. The third factor is posterior vitreous detachment, which occurs when the vitreous section of the eye moves away from the retina. Doctors call these three dispositions the trifecta, and when all three are present and combined with chronic inflammation, the result is likely to be FHI.
Although the presence of the three predisposing factors almost always precedes the development of Fuchs heterochromic iridocyclitis, it is not uncommon for patients to be symptom free for several years. When examined, patients’ eyes show small amounts of inflammation. Often, however, the chronic inflammation is not yet evident. Even redness and pain may not be noticed. The most obvious symptoms are decreased vision and floating spots.
After a diagnosis of Fuchs heterochromic iridocyclitis, patients may notice fluctuations in the condition and symptoms that occur. Symptoms may be scattered and may not include all possible symptoms in each flare-up. They can also flare up and be mild or worse each time. Most commonly, the vitreous detachment worsens and causes more floaters to appear.
The presence of glaucoma or cataracts requires medical attention. Glaucoma is treated with eye drops if it is detected during early development. Severe cases require surgical removal to avoid damage to the optic nerve. Cataracts are surgically removed when they interfere in a patient’s daily life.
Surgical treatment, other than that needed to remove glaucoma or cataracts, is usually not possible. Treatment for Fuchs heterochromic iridocyclitis includes topical corticosteroids to help reduce inflammation during a flare-up of symptoms. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage symptoms long-term. Low-grade inflammation generally doesn’t require treatment. If pain accompanies inflammation, doctors often recommend using over-the-counter pain relievers and hot or cold compresses on the affected eye.
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