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Synechia
Classification and external resources

Posterior synechia showing part of iris adherent to the lens
ICD-10 H21.5
ICD-9 364.7

A synechia is an eye condition where the iris adheres to either the cornea (i.e. anterior synechia) or lens (i.e. posterior synechia). Synechiae can be caused by ocular trauma, iritis or iridocyclitis and may lead to certain types of glaucoma. It is sometimes visible on careful examination but usually more easily through an ophthalmoscope or slit-lamp.

Anterior synechia causes closed angle glaucoma, which means that the iris closes the drainage way of aqueous humour which in turn raises the intraocular pressure. Posterior synechia causes glaucoma too but with a different mechanism, that due to adherence between iris and the lens block the way of aqueous from posterior chamber to the anterior chamber which in turn raises the intraocular pressure.

Management

Mydriatic/cycloplegic agents, such as topical atropine, are useful in breaking and preventing the formation of posterior synechia by keeping the iris mobile. Dilation of the pupil in an eye with synechia can cause the pupil to take an irregular (non-circular) shape as shown in the photograph. If the pupil can be fully dilated during the treatment of iritis, the prognosis for recovery from synechia is good. This is a treatable status.

To subdue the inflammation, use topical corticosteroids. If the intra-ocular pressure is elevated then use a Beta Blocker such as timolol.

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