Plateau iris

Plateau iris is a condition of the eye characterized by a specific configuration of the iris that can lead to angle-closure glaucoma. Unlike pupillary block, which is the most common mechanism for angle-closure glaucoma, plateau iris is caused by the abnormal position of the ciliary body and iris, leading to the iris being pushed forward. This results in a narrow angle between the iris and the cornea that can block the drainage of the aqueous humor, increasing intraocular pressure (IOP) and potentially damaging the optic nerve.

Causes

Plateau iris is primarily caused by an anatomical abnormality where the ciliary body is positioned more anteriorly than normal or is larger than usual. This causes the peripheral iris to be pushed forward, while the central iris remains in a normal position, creating a plateau-like appearance when viewed from the side. This condition can be congenital or acquired, but it is most often seen in individuals who are middle-aged or older.

Symptoms

Many individuals with plateau iris do not exhibit any symptoms until the condition progresses to angle-closure glaucoma. Symptoms of acute angle-closure glaucoma can include severe eye pain, headache, nausea, vomiting, blurred vision, and seeing halos around lights. Chronic angle-closure glaucoma may present with more subtle symptoms, such as gradual loss of peripheral vision.

Diagnosis

Diagnosis of plateau iris involves a comprehensive eye examination, including gonioscopy, which allows the eye care professional to view the angle between the iris and cornea directly. Imaging techniques such as ultrasound biomicroscopy (UBM) or anterior segment optical coherence tomography (AS-OCT) can also be used to provide detailed images of the anterior segment of the eye, helping to confirm the diagnosis.

Treatment

The initial treatment for plateau iris typically involves the use of eye drops that help to widen the angle between the iris and cornea, thereby facilitating aqueous humor drainage. In some cases, laser therapy, such as peripheral iridotomy or iridoplasty, may be recommended to create a hole in the iris or to shrink the peripheral iris, respectively. These procedures aim to reduce intraocular pressure and prevent or control glaucoma. In more severe cases, surgical intervention may be necessary to correct the anatomical abnormalities contributing to the condition.

Prevention and Management

Regular eye examinations are crucial for the early detection and management of plateau iris, especially for individuals at higher risk of developing angle-closure glaucoma. Patients diagnosed with plateau iris should be monitored closely by their eye care provider to ensure that the condition is managed effectively and to prevent the progression to glaucoma.

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