Traumatic iritis: Difference between revisions
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== | ==Background== | ||
*Classically blunt [[ocular Trauma|trauma]]: contusion and spasm of ciliary body and iris | |||
*May occur in any traumatic injury<ref>Augsburger JJ, Corrêa ZM. Chapter 19. Ophthalmic Trauma. In: Riordan-Eva P, Cunningham, Jr. ET, eds. Vaughan &amp;amp;amp;amp;amp; Asbury's General Ophthalmology. 18th ed. New York, NY: McGraw-Hill; 2011:371-382.</ref> | |||
*90% of uveitis is iritis, and traumatic iritis accounts for 20% of iritis<ref>Gutteridge IF, Hall AJ. Acute anterior uveitis in primary care. Clinical and Experimental Optometry. 2007. 90(2):70-82.</ref> | |||
== | ==Clinical Features== | ||
*Often delayed presentation after traumatic event, typically within 3 days of blunt [[ocular Trauma|trauma]] | |||
*[[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> | |||
Symptoms | |||
*[[blurred vision|Blurry vision]] in affected eye | |||
*Photophobia | |||
*[[Floaters]] | |||
*Tearing | |||
*Perilimbal conjunctival injection, ciliary flush | |||
*[[Vision loss|Decreased visual acuity]] | |||
*Sluggish pupil affected eye | |||
*Hallmark findings of consensual photophobia and “cell and flare” (anterior chamber) on slit limp examination | |||
**“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 | |||
**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> | |||
Complications: | |||
*Synechiae formation | |||
*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> | |||
[[Category: | ==Differential Diagnosis== | ||
{{Unilateral red eye DDX}} | |||
{{Acute vision loss noninflamed DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis | |||
==Management== | |||
#PO [[analgesia]] | |||
#[[Cycloplegic]]s paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>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.</ref> | |||
##[[Homatropine]] 5% BID-TID | |||
##[[Cyclopentolate]] 2% TID | |||
##[[Scopolamine]] 0.25% BID | |||
#[[Corticosteroids#Ophthalmic Steroids|Topical steroids]] in consult with optho | |||
##Rule out infection first and avoid corneal epithelial defect | |||
##[[Prednisolone]] acetate 0.5-1% QID | |||
#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== | |||
*[[Red eye]] | |||
*[[Eye pain]] | |||
==References== | |||
<references/> | |||
[[Category:Ophthalmology]] |
Latest revision as of 15:31, 5 October 2019
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 within 3 days of blunt trauma
- Eye pain, especially if not relieved by topical anesthetic[3]
Symptoms
- Blurry vision in affected eye
- Photophobia
- Floaters
- Tearing
- Perilimbal conjunctival injection, ciliary flush
- Decreased visual acuity
- Sluggish pupil affected eye
- Hallmark findings of consensual photophobia and “cell and flare” (anterior chamber) on slit limp examination
- “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
- May deposit onto corneal endothelium as keratic precipitates[4]
Complications:
- Synechiae formation
- 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
- 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
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Evaluation
- Clinical diagnosis
Management
- PO analgesia
- Cycloplegics paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain[6]
- Homatropine 5% BID-TID
- Cyclopentolate 2% TID
- Scopolamine 0.25% BID
- Topical steroids in consult with optho
- Rule out infection first and avoid corneal epithelial defect
- Prednisolone acetate 0.5-1% QID
- 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
- ↑ 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.
- ↑ Gutteridge IF, Hall AJ. Acute anterior uveitis in primary care. Clinical and Experimental Optometry. 2007. 90(2):70-82.
- ↑ 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.
- ↑ 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.