Traumatic iritis

(Redirected from Traumatic Iritis)


  • 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]


  • 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]


  • 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

^Emergent diagnoses ^^Critical diagnoses

Acute Vision Loss (Noninflamed)

Emergent Diagnosis


  • Clinical diagnosis


  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. Topical 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


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

See Also


  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.