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Traumatic iritis
From WikEM
Contents
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 24-48 hrs
- Eye pain, especially if not relieved by topical anesthetic[3]
- 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[4]
- 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
- Acute angle-closure glaucoma^
- Anterior uveitis
- Caustic keratoconjunctivitis^^
- Conjunctival laceration
- Conjunctivitis
- Corneal abrasion
- Corneal erosion
- Ocular foreign body
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Globe rupture^
- Herpes zoster ophthalmicus
- Intraocular foreign body
- Inflamed pingueculum
- Inflamed Pterygium
- Keratoconjunctivitis
- Keratoconus
- Lens dislocation
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Ultraviolet keratitis
^Emergent diagnoses
^^Critical diagnoses
Acute Vision Loss (Noninflamed)
- Arteritic anterior ischemic optic neuropathy
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Optic neuritis
- Posterior Reversible Encephalopathy Syndrome (PRES)
- Retinal detachment†
- Temporal arteritis†
- Traumatic optic neuropathy
- Vitreous hemorrhage
- Stroke†
†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 & 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.
