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Iritis

Fig. 2 Anterior chamber imflammation associated with iritis.

What is iritis?

The iris is the tissue around the pupil that determines eye color. Iritis is inflammation of the iris. White blood cells can be seen in the front part of the eye (anterior chamber) by an ophthalmologist using a microscope known as a slit lamp. In more severe cases, white blood cells can adhere to the back of cornea or even settle in a layer (hypopyon) [See figures 1 and 2].

What causes iritis?

There are many causes of /and or associated illnesses with iritis and include: trauma, infection (bacterial and viral), immune system abnormalities, Juvenile Idiopathic Arthritis (JIA), gastrointestinal diseases (ulcerative colitis and Crohn disease), nephritis, reactive arthritis, leukemia and Kawasaki syndrome. JIA is one of the more common associations with iritis and these children often require routine screening for inflammation in the eye.

What are the symptoms of iritis?

Children with symptomatic iritis may complain of pain, light sensitivity, decreased vision, red eye, and headache and/or irregularly shaped pupils.

The iritis associated with JIA is usually asymptomatic. Examinations with an ophthalmologist up to 3 to 4 times yearly are suggested to monitor for unrecognized inflammation.

Fig. 2 Synechiae, inflammatory adhesions between the iris and lens surface.

What are the complications of iritis?

Iritis may cause other ocular problems including iris attachments to the lens (posterior synechiae) or other eye structures (peripheral anterior synechiae) cataract, glaucoma, inflammation in the vitreous (vitritis) and retina (retinitis) as well as calcium accumulation on the cornea (band keratopathy). These problems can cause severe visual loss, including blindness.

What tests are ordered?

The tests ordered depend on clinical symptoms and signs and may include antinuclear antibodies (ANA), rheumatoid factor (RF), HLA-B27 haplotype, sedimentation rate, chest CAT scan (CT), gallium scan and sacroiliac films. In the case of suspected sarcoidosis, a tissue biopsy may be performed..

How is iritis treated?

The effective treatment of acute or chronic eye inflammation often requires collaboration between an ophthalmologist and pediatric subspecialists.

Fig. 3 Band keratopathy, calcium deposits on the corneal surface.

Medications

Treatment often depends on the severity of the ocular inflammation Topical or periocular steroids may be prescribed. Oral nonsteroidal anti-inflammatory drugs or steroid medications may also be initiated. Other systemic medications utilized include methotrexate, infliximab (Remicade) and etanercept (Embrel). Dilating eye drops may be used to prevent the iris from sticking to other ocular tissues, most notably the lens. Medications for glaucoma are sometimes required.

Surgery

If calcium accumulates on the cornea, surgical removal may be indicated. An iritis/steroid induced cataract may necessitate surgical removal [See figure 3].

Resources

For more information, you can access the following web sites

Ocular Immunology and Uveitis Foundation
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American Uveitis Society
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American Academy of Ophthalmology
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