From the Guidelines
Pupillary synechiae in a 9-year-old girl are most commonly caused by anterior uveitis, particularly in the context of juvenile idiopathic arthritis (JIA). These adhesions form when inflammation causes the iris to stick to either the lens (posterior synechiae) or the cornea (anterior synechiae) 1. Other potential causes include:
- Trauma
- Infection (such as herpes simplex virus, tuberculosis, or toxoplasmosis)
- Less commonly, congenital conditions or complications from previous eye surgeries
Management requires prompt referral to a pediatric ophthalmologist for evaluation and treatment with:
- Topical corticosteroids (such as prednisolone acetate 1% drops 4-6 times daily)
- Cycloplegic agents (like cyclopentolate 1% or atropine 0.5-1% twice daily) to reduce inflammation and prevent further adhesion formation 1. Systemic evaluation for underlying conditions, particularly JIA, is essential as uveitis can be asymptomatic in children yet cause permanent vision damage. Early detection and aggressive treatment are crucial as synechiae represent advanced inflammation that can lead to complications including cataracts, glaucoma, and permanent vision loss if not properly managed 1.
According to the 2019 American College of Rheumatology/American Academy of Pediatrics guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis, uncontrolled chronic anterior uveitis (CAU) can lead to sight-threatening complications such as synechiae, cataracts, and glaucoma in 25–50% and vision loss in 10–20% of children with uveitis 1. Initial treatment of children with JIA-associated uveitis typically includes topical glucocorticoids, and in those who are refractory to, or dependent on, topical glucocorticoids, methotrexate is the usual first-line systemic immunosuppressive agent 1.
From the Research
Causes of Pupillary Synechiae
There are no direct causes of pupillary synechiae mentioned in the provided studies. However, some studies mention conditions that may lead to complications in the eye, which could potentially cause pupillary synechiae.
- Uveitis, which is the inflammation of any or all parts of the vascular tunic of the eye, can cause complications such as posterior synechia 2.
- Ocular inflammation and infection may involve any part of the eye and surrounding tissue, but the studies do not specifically mention pupillary synechiae as a cause or effect 3.
- A sphenoid sinus mucocele (SSM) can cause acute visual loss in a young child, but there is no mention of pupillary synechiae in this study 4.
- Other studies mention various conditions such as fever, rash, and lymphadenopathy, but these are not directly related to pupillary synechiae 5.
- A case report of a persisting nictitating membrane in a 9-year-old girl does not mention pupillary synechiae as a cause or effect 6.
Related Conditions
Some of the studies mention conditions that may be related to pupillary synechiae, such as: