Traumatic iritis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Often delayed presentation after traumatic event, typically 24-48 hrs | *Often delayed presentation after traumatic event, typically 24-48 hrs | ||
*[[Eye pain]] | *[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref> | ||
*Decreased visual acuity in affected eye | *Decreased visual acuity in affected eye | ||
*Photophobia (direct and consensual) | *Photophobia (direct and consensual) | ||
*Sluggish pupil | *Sluggish pupil | ||
*Cell & flare | *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) | **“Cell:” individual cells floating in the anterior chamber (look like dust specks) | ||
**“Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke) | **“Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke) | ||
**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref> | **May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref> | ||
*Vossius' ring on anterior lens capsule | |||
*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<ref>Trevor-Roper PD, Curran PV. The Eye and Its Disorders. Boston, MA: Blackwell Scientific Publications; 1984:489-507.</ref> | *IOP may be increased due to inflammation, damage to ciliary body, or circumferential synechial formation<ref>Trevor-Roper PD, Curran PV. The Eye and Its Disorders. Boston, MA: Blackwell Scientific Publications; 1984:489-507.</ref> | ||
Revision as of 21:31, 24 July 2016
Background
- Classically blunt trauma: contusion and spasm of ciliary body and iris
- May occur in any traumatic injury[1]
- Iridocyclitis because both the iris and the underlying ciliary body are inflamed
- Iritis
- HLA-B27 antigenic marker also strongly linked to spondyloarthritis such as ankylosing spondylitis
Clinical Features
- Often delayed presentation after traumatic event, typically 24-48 hrs
- Eye pain, especially if not relieved by topical anesthetic[2]
- 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[3]
- 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[4]
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Diagnosis
- Clinical diagnosis
Management
- Cycloplegics (eg. Homatropine 5%, or cyclopentolate 2%, 3 times per day until ophthalmology follow-up): paralyzes the ciliary body resulting in a nonreactive, dilated pupil
- PO analgesia
- Steroids in consult with optho (rule out infection first)
Disposition
Follow up with optho in 24-48 hours
See Also
References
- ↑ Augsburger JJ, Corrêa ZM. Chapter 19. Ophthalmic Trauma. In: Riordan-Eva P, Cunningham, Jr. ET, eds. Vaughan &amp;amp;amp;amp; Asbury's General Ophthalmology. 18th ed. New York, NY: McGraw-Hill; 2011:371-382.
- ↑ Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.
- ↑ Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.
- ↑ Trevor-Roper PD, Curran PV. The Eye and Its Disorders. Boston, MA: Blackwell Scientific Publications; 1984:489-507.