Iritis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Iritis is a form of anterior uveitis and refers to the inflammation of the iris of the eye.

Types

There are two main types of iritis: acute and chronic. Acute iritis is a type of iritis that can heal independently within a few weeks. If treatment is provided, acute iritis improves quickly. Chronic iritis can exist for months or years before recovery occurs. Chronic iritis does not respond to treatment as well as acute iritis does. Chronic iritis is also accompanied by a higher risk of serious visual impairment.

Signs and symptoms

• Ocular and periorbital pain
• Photophobia
• Consensual photophobia (pain in affected eye when light is shone in unaffected eye)
• Blurred or cloudy vision
• Reddened eye, especially adjacent to the iris
• White blood cells (leukocytes) (resulting in a grey or near-white haze) and protein (resulting in tiny white dots) in the anterior chamber, often called "cells and flare."
• Synechia or adhesion of iris to lens or cornea

Causes

Life Threatening Causes

• Sarcoidosis
• Syphilis
• Tuberculosis
• Toxoplasmosis
• Wegener's granulomatosis

Common Causes

• Ankylosing spondylitis
• HLA-B27 disorder
• Meclofenamate
• Medrysone
• Trametinib
• Tetracaine
• Behçet's disease
• Crohn's disease
• Systemic lupus erythematosus
• Reiter's disease
• Chronic psoriasis
• Psoriatic arthritis
• Sarcoidosis
• Scleroderma
• Ulcerative colitis

Causes by Organ System

Cardiovascular	Autoimmune retinal vasculitis, Ocular ischemic syndrome
Chemical/Poisoning	Box jellyfish poisoning
Dental	No underlying causes
Dermatologic	Behçet's disease, Chronic psoriasis, Dermatostomatitis, Lepromatous leprosy, Psoriatic arthritis, Stevens-johnson syndrome
Drug Side Effect	Etidronate, Fomivirsen sodium, Meclofenamate, Medrysone, Pembrolizumab, Rifabutin, Tetracaine, Trametinib, Vemurafenib
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Foreign body
Gastroenterologic	Crohn's disease, Inflammatory bowel disease, Ulcerative colitis, Ulcerative proctosigmoiditis
Genetic	Alezzandrini syndrome, Blau syndrome, Hla-b27 disorder, Phosgene oxime
Hematologic	Granulomatosis with polyangiitis, Wegener's granulomatosis
Iatrogenic	No underlying causes
Infectious Disease	Cat scratch fever, Dabrafenib, Euphorbiaceae , Herpes simplex, Herpes zoster, Htlv-1, Lepromatous leprosy, Leptospirosis, Lyme disease, Malaria, Mycobacterium tuberculosis, Onchocerciasis, Secondary syphilis, Syphilis, Toxocariasis, Toxoplasmosis, Tuberculosis, Ulcerative proctosigmoiditis , Weil's syndrome
Musculoskeletal/Orthopedic	Ankylosing spondylitis, Connective tissue diseases, Polychondritis
Neurologic	Charlin's syndrome, Heerfordt-waldenstroem syndrome, Multiple sclerosis
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	Autoimmune retinal vasculitis, Birdshot retinochoroidopathy, Charlin's syndrome, Fuchs' heterochromic cyclitis, Incontinentia pigmenti, Ocular ischemic syndrome, Pars planitis, Sympathetic ophthalmitis, Vogt-koyanagi-harada syndrome
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Sarcoidosis, Tuberculosis
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Ankylosing spondylitis, Behçet's disease, Birdshot retinochoroidopathy, Blau syndrome, Chronic psoriasis, Granulomatosis with polyangiitis, Heerfordt-waldenstroem syndrome, Juvenile chronic arthritis, Juvenile rheumatoid arthritis , Psoriatic arthritis, Reactive arthritis, Reiter's disease, Rheumatoid arthritis, Rheumatoid disease, Sarcoidosis, Scleroderma, Still's disease, Systemic lupus erythematosus, Vogt-koyanagi-harada syndrome, Wegener's granulomatosis
Sexual	Secondary syphilis, Syphilis
Trauma	Blunt trauma
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Alezzandrini syndrome
• Ankylosing spondylitis
• Autoimmune retinal vasculitis
• Behçet's disease
• Birdshot retinochoroidopathy
• Blau syndrome
• Blunt trauma
• Box jellyfish poisoning 
• Cat scratch fever
• Charlin's syndrome
• Chronic psoriasis
• Connective tissue diseases
• Crohn's disease
• Dabrafenib
• Dermatostomatitis
• Etidronate
• Euphorbiaceae 
• Fomivirsen sodium
• Foreign body
• Fuchs' heterochromic cyclitis
• Granulomatosis with polyangiitis
• Heerfordt-waldenstroem syndrome
• Herpes simplex
• Herpes zoster
• Hla-b27 disorder
• Htlv-1
• Incontinentia pigmenti
• Inflammatory bowel disease
• Juvenile chronic arthritis
• Juvenile rheumatoid arthritis 
• Lepromatous leprosy
• Leptospirosis
• Lyme disease
• Malaria
• Meclofenamate
• Medrysone
• Multiple sclerosis
• Mycobacterium tuberculosis
• Ocular ischemic syndrome
• Onchocerciasis
• Pars planitis
• Pembrolizumab
• Phosgene oxime
• Polychondritis
• Psoriatic arthritis
• Reactive arthritis
• Reiter's disease
• Rheumatoid arthritis
• Rheumatoid disease
• Rifabutin
• Sarcoidosis
• Scleroderma
• Secondary syphilis
• Stevens-johnson syndrome
• Still's disease
• Sympathetic ophthalmitis
• Syphilis
• Systemic lupus erythematosus
• Tetracaine
• Toxocariasis
• Toxoplasmosis
• Trametinib
• Tuberculosis
• Ulcerative colitis
• Ulcerative proctosigmoiditis 
• Vemurafenib
• Vogt-koyanagi-harada syndrome
• Wegener's granulomatosis
• Weil's syndrome

Complications

Complications of iritis may include the following: Cataract, glaucoma, corneal calcification, posterior uveitis, blindness, band keratopathy, and cystoid macular oedema.

Treatment

• Steroid anti-inflammatory eye drops (such as prednisolone acetate)
• Dilating eye drops (to help prevent synechia and reduce photophobia)
• Pressure-reducing eye drops (such as brimonidine tartrate)
• Oral steroids (such as prednisone)
• Subconjunctival steroid injections
• Steroid-sparing agents such as methotrexate (for prolonged, chronic iritis)

External links

• Care of the Patient with Anterior Uveitis (CPG7) (PDF)
• Iritis Organization
• Assessment of the Red Eye - Iritis
• Medical Info on Iritis