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Iritis

Specialties > Ophthalmology

Background knowledge 🧠

Definition

  • Iritis is a form of anterior uveitis characterized by inflammation of the iris.
  • It can be acute or chronic, with acute cases often presenting suddenly.
  • Commonly associated with autoimmune conditions.
  • A subtype of uveitis, which encompasses inflammation of the uveal tract.

Epidemiology

  • Most common in young to middle-aged adults.
  • Incidence is higher in individuals with HLA-B27 related conditions.
  • Slight male predominance in HLA-B27 associated iritis.
  • May occur more frequently in patients with a history of autoimmune or inflammatory diseases.

Aetiology and Pathophysiology

  • Idiopathic in about half of cases.
  • Associated with systemic diseases such as ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, and sarcoidosis.
  • Infectious causes include herpes simplex, herpes zoster, and tuberculosis.
  • Involves breakdown of the blood-ocular barrier, leading to inflammation.

Types

  • Acute Iritis: Sudden onset, often associated with redness, pain, and photophobia.
  • Chronic Iritis: Persistent inflammation, often with milder symptoms but risk of complications.
  • Granulomatous: Characterized by large keratic precipitates, commonly linked with sarcoidosis or tuberculosis.
  • Non-Granulomatous: More common, associated with HLA-B27 conditions, and has smaller keratic precipitates.

Clinical Features 🌡️

Symptoms

  • Eye pain, often described as aching.
  • Photophobia, or sensitivity to light.
  • Blurred vision or visual disturbance.
  • Redness, particularly around the limbus (ciliary flush).
  • Possible headache localized to the affected side.

Signs

  • Ciliary injection (redness around the cornea).
  • Keratic precipitates on the corneal endothelium.
  • Anterior chamber cells and flare on slit-lamp examination.
  • Posterior synechiae, where the iris adheres to the lens.
  • Hypopyon in severe cases (layering of white blood cells in the anterior chamber).

Investigations 🧪

Tests

  • Slit-lamp examination to assess anterior chamber cells, flare, and keratic precipitates.
  • Intraocular pressure measurement to rule out secondary glaucoma.
  • Fluorescein staining to check for corneal involvement.
  • Blood tests including ESR, CRP, HLA-B27, and syphilis serology in cases of suspected systemic involvement.
  • Chest X-ray or CT scan for sarcoidosis if granulomatous uveitis is suspected.

Management 🥼

Management

  • Topical corticosteroids (e.g., prednisolone) to reduce inflammation.
  • Cycloplegic agents (e.g., cyclopentolate) to prevent posterior synechiae and reduce pain.
  • Systemic corticosteroids for severe or refractory cases.
  • Treat underlying systemic disease if present (e.g., immunosuppressants for autoimmune conditions).
  • Regular follow-up to monitor response and prevent complications.

Complications

  • Cataract formation due to prolonged inflammation or steroid use.
  • Glaucoma from increased intraocular pressure.
  • Posterior synechiae leading to irregular pupil shape.
  • Cystoid macular oedema, a cause of vision loss.
  • Recurrent episodes, especially if underlying systemic condition is not controlled.

Prognosis

  • Good prognosis with early and appropriate treatment.
  • Risk of recurrence, particularly in patients with systemic inflammatory conditions.
  • Prolonged or recurrent cases may lead to chronic visual impairment.
  • Prognosis worsens with delayed treatment or if complications arise.

Key Points

  • Iritis is a potentially sight-threatening condition requiring prompt treatment.
  • Commonly associated with systemic diseases, so thorough history-taking is essential.
  • Regular monitoring and follow-up are crucial to prevent complications.
  • Consider referral to a specialist for chronic or complicated cases.

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Ophthalmology