Fuch's heterochromic cyclitis
 

There are small keratic precipitates scattered throughout the corneal endothelium (stellate  keratic precipitates). The iris shows hypochromia (best seen in the day light) iris transillumination  due to iris atrophy. There may be irregular fine vessels on the iris. The patient may have posterior subcaspular cataract. The anterior chamber may have flare or  cells. However, the conjunctiva is white. Posterior synechia does not occur. Further examination: the iris may contain abnormal iris vessels check for the presence of trabeculectomy

Questions:

1. How do you manage a patient with Fuch's heterochromic cyclitis?

Answer
Three main areas need consideration:
Uveitis, this tends to be chronic and not responsive to steroid. Steroid may increase the risk of glaucoma and cataract
Glaucoma. May respond initially to medical treatment and trabeculectomy is usually needed. However, as bleb failure is common use of antimetabolite is recommended
Cataract. Extraction and heparin surface-modified implant is usually successful.

2. What are the complications of cataract operation in Fuch's heterochromic cyclitis?

Answer
Preoperatively, the pupil may not dilate well due to iris atrophy.
Perioperatively, hyphaema from the abnormal iris vessels is common (Amsler's sign)

3. What are the differential diagnosis of heterochromia?

Answer
The abnormal eye may be:
hypochromic and the causes include idiopathic, congenital Horner's syndrome, chronic uveitis, post-cataract operation, pigment dispersion syndrome, Waardenburg's syndrome and post-herpes zoster iritis
hyperchromic - melanosis, iris naevus syndrome, rubeosis iridis and siderosis.

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