Iritis is a form of anterior uveitis, characterized by the inflammation of iris. It is often idiopathic but may also be triggered by infections and trauma.
In general, patients with iritis have normal lashes, lids and lacrimal ducts. Conjunctiva may show perilimbal injection with increasing intensity near the limbus. In conjunctivitis the inflammation is away from the limbus, and this helps to differentiate between the two conditions. Patients present with decreased acuity in the eye with iris inflammation. Patient may have photophobia, particularly when light is directed to the pupil during examination. They may also have consensual photophobia, characterized by photophobia when light is directed to the unaffected eye. This feature also helps to distinguish between conjunctivitis and iritis. In conjunctivitis, consensual photophobia is lacking.
On slit lamp examination, epithelium may show abrasions, ulcers, presence of foreign bodies, or edema. Stroma may have deep ulcers. Endothelium may show keratitic precipitation which may be non-granulomatous or granulomatous in nature. Small to medium keratitic precipitation are classified as non-granulomatous, while large ones with greasy ones are known at as granulomatous keratitic precipitation. Presence of flare in the anterior chamber on slit lamp examination is the most characteristic feature of iritis. This is caused by an increase in the protein content in the anterior chamber. Presence of white or red blood cells may also be noted in the anterior chamber. The appearance of the chamber is graded from faint to intense, when fibroid deposits are noted.
Some of the common manifestations of the acute iritis include pain, reddishness, photophobia, excessive tearing and difficulty in vision. Pain in the eyes may develop over a few hours to days. But if the etiology is trauma, there may be sudden onset of pain [7]. Chronic iritis is characterized by blurred vision, mild red color in the eyes, and pain. Pain is relatively less when compared to acute form of iritis.
In most of the cases, history of the patient plays a major role in finding the etiology of iritis. Laboratory studies are not needed in iritis, particularly in presence of a systemic disease or with a history of trauma. Trauma with the typical symptoms, implies the presence of iritis. Workup is often helpful in case of granulomatous, recurrent or bilateral uveitis. Some of the common laboratory studies used in the diagnosis of the condition include complete blood count, erythrocyte sedimentation rate (ESR), antinuclear antibody, test for HLA-B27 and Lyme titer.
Concomitant corneal injury can be assessed using fluorescein staining [7]. Glaucoma is differentiated by measuring the intraocular pressure. Slit lamp examination is often the best diagnostic tool used in iritis. This method reveals the presence of cells and flares in the anterior chamber. Occasionally, posterior synechiae characterized by fibrin strands adhering the pupil to lens can be noted. Pen torch examination may reveal reddishness of conjunctiva which is more prominent around the periphery of iris. Pupil is often constricted. In recurrent iritis, pupil may appear distorted due to fibrinous adhesions on anterior lens surface. In severe cases, clump of white cells can be noted on the anterior iris.
Systemic investigations are not recommended for the first episode of iritis. But if the symptoms are prolonged or if the inflammation is severe, systemic investigation may be suggested. Subsequent flare-ups of symptoms should be followed up with immune profile, ESR, tests for syphilis, and radiology. Glaucoma and posterior synechiae are the most common complications associated with iritis. Severe forms may involve posterior uvea and retina, which may lead to impairment of vision.
The presupposition for any treatment is accurate diagnosis [8]. Mild cases of iritis may resolve on its own without any specific treatment. If ciliary muscle spasms are present, cycloplegic eye drops may be used. This will also help to reduce the chances of synechiae and improve the symptoms considerably. Topical corticosteroids are considered in case of mild to moderate forms of iritis [9]. Topical steroids reduce the inflammatory response. For acute iritis, periocular steroid injections and systemic anti-inflammatory treatments are usually recommended. This strategy is particularly true if inflammation is present in posterior ocular tissue. Steroids are gradually reduced in dose and frequency over several weeks depending on the response to treatment [10]. Immunosuppressant is occasionally recommended in case of increased risk of vision loss. If infection is the etiological cause of the condition, antibiotics or antivirals are prescribed.
In acute cases of iritis, follow-up should be done every week and includes slit lamp examination and measurement of intraocular pressure. Once the symptoms improve, follow up is done every 6 months.
In general, uveitis and iritis have a good prognosis when appropriate treatment is provided. Iritis responds well to treatment with steroid eye drops and dilating eye drops. Possibility of scarring, glaucoma and cataract increases with recurrence of iritis or any other form of anterior uveitis. But when promptly treated, even recurrent iritis has a good outcome. Treatment with topical steroids should be initiated only after slit lamp examination. Further, treatment should be followed up regularly to check for response and the possible comorbidities.
About 50% of the patients has idiopathic uveitis and this is not associated with any other systemic conditions or syndromes. Traumatic and non-traumatic etiologies are also found to be implicated in the development of iris inflammation. Many systemic diseases are found to be associated with iritis and include:
Juvenile rheumatoid arthritis is also found to be associated with iritis. This is relatively more serious and may not respond well to treatment. Pain is generally absent in children with arthritis. Hence, even slight reddishness in the eyes of children should not be ignored. Infections like Lyme disease, toxoplasmosis, syphilis, and herpes may also result in this inflammation [2]. Blunt trauma to the iris is yet another cause of this condition. HLA B27 haplotype is found to predispose people to uveitis.
Uveitis, both anterior and posterior, is an uncommon condition. It is more commonly seen in the age group of 20 to 59 years. Occasionally it can be seen in children too. Both of the genders are equally affected by iritis. This condition is found to be more prevalent in Finland where the annual incidence is about 23 cases in 100,000 persons. The increased incidence of iritis may be due to increased frequency of HLA B27 genes in the population [3]. In the US the annual incidence of uveitis is about 12 in 100,000 persons.
In most of the cases, the cause of iritis is not known. In infectious anterior uveitis, the immune reaction against an infectious agent or foreign material is implicated in the development of the condition, resulting in inflammation [4].
Blunt trauma to iris may lead to accumulation of necrotic products at the site. Trauma may also result in microbial contamination of iris. Both these conditions are known to stimulate the inflammatory process at the injured site. The localized inflammatory response is often caused by a sudden and transient increase in the pressure of anterior chamber [5]. Trauma may also lead to tearing of the iris resulting in local vascular damage. These reactions further increase the inflammatory process. Occasionally, the iris sphincter constricts in the presence of prostaglandins and leads to miotic pupil. Anterior uveitis is also associated with autoimmune disorders. These disorders are characterized by hypersensitivity reaction that results in accumulation of immune complexes in uveal tract.
About 34% of the patients with anterior uveitis, including iritis, has idiopathic etiology [6]. Seronegative arthropathies and juvenile rheumatoid arthritis also result in this condition in 21.6% and 10.8%, respectively.
Very little can be done to prevent the occurrence of this eye condition. It is difficult to prevent recurrence of the condition too. Often, inflammation in some part of the body may trigger another episode of the disease. Keeping the inflammation to minimum, by treating the underlying disease, often helps in controlling the symptoms to a large extent.
Iritis is a form of anterior uveitis, characterized by the inflammation of iris. The condition is often idiopathic but may also be triggered by infections and trauma. Anterior uveitis is the most common form of uveitis and accounts for 75% of the cases of uveal inflammation. Iritis may be acute or chronic depending on the symptoms. Acute form of iris inflammation is manifested by reddishness, photophobia and extreme tearing [1]. Chronic form is characterized by mild reddishness and blurred vision. Leukocytes are shed into the anterior chamber of the eye, which can be observed using stilt lamp. Treatment depends on the actual cause of the disease. When compared to posterior uveitis, it is less severe and has a good prognosis. If treated appropriately, one can prevent recurrent iritis and permanent eye damage successfully.
Iritis is the inflammation of iris (the colored portion of the eye) characterized by pain, redness, blurred vision and sensitivity to light. Depending on the intensity of symptoms, it may be categorized into acute and chronic. Infection and inflammation are the two most common causes of iritis. Trauma to the eye may result in inflammation. Iritis may also be seen as a complication of diseases like juvenile rheumatoid arthritis, ankylosing spondylitis, tuberculosis and syphilis. It may also occur with herpes simplex of the eye. In many cases, no specific cause can be found. Iritis may occur in one or both eyes. Pain, reddishness, blurred vision and sensitivity to light are the most common symptoms of this eye disease. Symptoms may occur gradually or have a sudden onset.
As underlying diseases may be a cause of iritis, ophthalmologist often refer the patient to a specialist. It is important to determine the actual cause of the disease. Complete medical history and symptoms of the patient are very important in the diagnosis of the disease. Suspicions are confirmed with diagnostic tools. Once vision is measured, slit lamp examination is conducted. This reveals the inflammatory cells in the anterior part of the eye. It also shows foggy nature of the anterior chamber. Pressure of the involved eye is often lesser than the unaffected eye.
When diagnosed and treated immediately, iritis has a good prognosis. If left untreated, it may lead to cataract, glaucoma, retina edema and even permanent vision loss. Antibiotics or antivirals are recommended if infection is the cause of iritis. In some cases, corticosteroids are given in combination. Steroids may be given as an injection or as eye drops. This helps in reducing inflammation. Immunosuppressants are suggested if there is a risk of vision loss or in the presence of severe symptoms. Mydriatic eye drops helps to eye pain and also prevent the pupil from sticking to the lens.