Traumatic iritis

Background

• Blunt trauma: contusion and spasm of ciliary body and iris
• 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

• 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
    • Ocular compartment syndrome
  • Traumatic hyphema
  • Traumatic iritis
  • Traumatic mydriasis
  • Traumatic optic neuropathy
  • Vitreous detachment
  • Vitreous hemorrhage
  • Ultraviolet keratitis

^Emergent diagnoses ^^Critical diagnoses

Diagnosis

• Clinical diagnosis

Treatment

1. Cycloplegics (eg. homotyptine 5%, or cyclopentolate 2%, 3 times per day until ophthalmology follow-up): paralyzes the ciliary body resulting in a nonreactive, dilated pupil
2. PO analgesia
3. Steroids in consult with optho (rule out infection first)

Disposition

F/u with optho in 24-48 hours

References

• PEER VIII Q&A