Iritis/ Iridocyclitis

DEFINITION:
§ Iritis is uveitis, inflammation of the uveal tract, predominantly affecting the iris.
§ Iridocyclitis involves inflammation of the ciliary body as well as the iris.

CLASSIFICATION:
§ Acute: sudden symptomatic onset, persisting for 6wks or less
§ Chronic: lasts for months or year, can be asymptomatic. Chronic uveitis is usually associated with systemic disorders including    ankylosing spondylitis (also associated with acute anterior uveitis), Behçet's syndrome, inflammatory bowel disease, juvenile    rheumatoid arthritis, Reiter's syndrome, sarcoidsis (granulomatous), syphilis, tuberculosis, and Lyme disease. A blood work-up    may be indicated (i.e. HLA-B27 for ankylosing spondylitis or Reiter's) or a chest X-ray (sarcoidosis or tuberculosis).
§ Exogenous: external uveal injury or invasion of microbes from outside the patient
§ Endogenous: microbes or other agents from within the patient
§ Granulomatous: has large 'mutton fat' keratic precipitates
§ Non-granulomatous: smaller keratic precipitates

SYMPTOMS:
§ Photophobia
§ Pain
§ Redness
§ Blurred vision
§ Lacrimation
§ Miosis

SIGNS:
1. Ciliary injection in bulbar conj causes rednes
2. Keratic precipitates (KP)-cellular deposits on the endothelium, usually in the mid and inferior zones of the cornea
           § Small KP-Herps es Zoster, Fuchs' uveitis
           § Medium KP-most types of acute and chronic uveitis
           § Large KP-'mutton fat', greasy, waxy; granulomatous uveitis
           § Fresh KP-white, round; these shrink with age and become faded and pigmented
3. Iris nodules-granulomatous inflammation within iris stroma
           § Koeppe nodules-small, located at pupillary border
           § Busacca nodules-larger, on iris away from pupil
4. Aqueous Cells-white blood cells in the aqueous; a sign of active inflammation
5. Aqueous Flare-protein from the inflamed iris or ciliary body which gives the aqueous a smoky or particulate appearance;     presence does not necessarily indicate active inflammation
6. Posterior synechiae-adhesions between the iris and the anterior lens casule. If these adhesions extend 360° around the iris,     then the passage of aqueous from the posterior to anterior chamber is prevented, leading to iris bombé, a forward bowing of     the peripheral iris
7. Decreased IOP-the intraocular pressure in the affected eye is initially reduced due to secretory hypotony of the ciliary body.     Eventually, inflammatory by-products accumulate in the trabeculum and if the CB resumes its normal secretory output, the IOP     may increase significantly and result in secondary uveitic glaucoma.

TREATMENT:
1. Mydriatics and Cycloplegics-immobilizing the iris and CB decreases pain. They also break /prevent posterior synechiae     formation. Examples are homatropine 5% TID/QID, scopolamine 0.25% BID/QID, or atropine 1% BID.
2. Topical Steroid-to decrease the inflammatory response. Examples are PredForte (prednisolone) or Maxidex (dexamethasone)     Q2-3H.