Traumatic iritis
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
- Decreased visual acuity in affected eye
- Photophobia (direct and consensual)
- Sluggish pupil
- Cell & flare
- “Cell:” individual cells floating in the anterior chamber (look like dust specks)
- “Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke)
- Hypopyon (severe cases): leukocytic exudate in anterior chamber
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
- PEER VIII Q&A
- ↑ 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.