Traumatic iritis

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Background

  • Classically blunt trauma: contusion and spasm of ciliary body and iris
  • May occur in any traumatic injury[1]
  • 90% of uveitis is iritis, and traumatic iritis accounts for 20% of iritis[2]

Clinical Features

  • Often delayed presentation after traumatic event, typically 24-48 hrs
  • Eye pain, especially if not relieved by topical anesthetic[3]
  • Decreased visual acuity in affected eye
  • Photophobia (direct and consensual)
  • Sluggish pupil
  • Hypopyon (severe cases): leukocytic exudate in anterior chamber
  • Cell & flare (anterior chamber reaction)
    • “Cell:” individual cells floating in the anterior chamber (look like dust specks)
    • “Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke)
    • May deposit onto corneal endothelium as keratic precipitates[4]
  • Vossius' ring on anterior lens capsule
    • Due to concussive force of posterior iris onto lens
    • Depositing pigment in the pattern of a miosed pupil onto anterior lens
  • IOP may be increased due to inflammation, damage to ciliary body, or circumferential synechial formation[5]

Differential Diagnosis

Unilateral Red Eye

^Emergent diagnoses

^^Critical diagnoses

Acute Vision Loss (Noninflamed)

Emergent Diagnosis

Evaluation

  • Clinical diagnosis

Management

  1. PO analgesia
  2. Cycloplegics paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain[6]
    1. Homatropine 5% BID-TID
    2. Cyclopentolate 2% TID
    3. Scopolamine 0.25% BID
  3. Steroids in consult with optho
    1. Rule out infection first and avoid corneal epithelial defect
    2. Prednisolone acetate 0.5-1% QID
  4. If secondary glaucoma as complication, may use timolol 0.5% BID if no contraindication

Disposition

  • Follow up with optho in 24-48 hours, but 5-7 days may be acceptable on a case by case basis

See Also

References

  1. Augsburger JJ, Corrêa ZM. Chapter 19. Ophthalmic Trauma. In: Riordan-Eva P, Cunningham, Jr. ET, eds. Vaughan & Asbury's General Ophthalmology. 18th ed. New York, NY: McGraw-Hill; 2011:371-382.
  2. Gutteridge IF, Hall AJ. Acute anterior uveitis in primary care. Clinical and Experimental Optometry. 2007. 90(2):70-82.
  3. Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.
  4. Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.
  5. Trevor-Roper PD, Curran PV. The Eye and Its Disorders. Boston, MA: Blackwell Scientific Publications; 1984:489-507.
  6. Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.

Authors

Michael Holtz