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Ocular System

Fuchs heterochromic iridocyclitis (FHI)

Anterior uveitis of unknown etiology characterized by diffuse stellate keratic precipitates (KP) with iris heterochromia.

  • Triad:
    1. Heterochromia
    2. Predisposition to cataract & glaucoma
    3. Keratitic precipitates on the posterior corneal surface

History:

Ernst Fuchs was the first in 1906 to report both the clinical and pathologic features of a consistent number of patients with a chronic low grade anterior chamber inflammation, heterochromia, and cataract. This association was named after as Fuchs’ Heterochromic Iridocyclitis (FHI). Nowadays FHI is one of the most common forms of anterior uveitis, accounting for up to 8% of endogenous uveitis seen in referral center.


Aetiology

Aetiology is unknown.

Associated conditions:

Secondary to which FHIC may develop
  • Toxoplasmosis, toxocariasis
  • Sarcoidosis
  • Rubella vaccination
  • Cytomegalovirus (CMV), herpes simplex virus, chikungunya virus infections
  • Retinitis pigmentosa
  • Horner’s syndrome
  • Usher’s syndrome
  • Previous trauma

Clinical features

Slow progression over time, without substantial reduction of visual acuity until the development of significant vitreous opacities or cataract.

  • Blurred vision (M/C)
  • Mild discomfort

Complications

  • Cataract
  • Secondary glaucoma (M/serious)
    • Refractory to medical management
  • Vitreous opacities

Diagnosis

Usually diagnosed 2 years after symptoms onset on average.

Slit lamp photograph. Showing Fuchs heterochromic iridocyclitis (A) and the normal other eye (B) in diffuse illumination. | Babu, K., Adiga, M., Govekar, S. R., Kumar, B. R., & Murthy, K. R. (2013). Associations of Fuchs heterochromic iridocyclitis in a South Indian patient population. Journal of ophthalmic inflammation and infection, 3(1), 14. https://doi.org/10.1186/1869-5760-3-14
  • Keratic precipitates (M/C)
  • Iris heterochromia
  • Iris atrophy (moth-eaten appearance)

Amsler–Verrey sign:

Presence of blood (hyphema) in the aspirated vitreous fluid, in paracentesis of the anterior chamber

Due to iris atrophy usually seen in FHI and exposure of the fragile iris vasculature to the vitreous fluid


Management

  • Short course of topical corticosteroids (DOC)

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