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]

• Often delayed presentation after traumatic event, typically within 3 days of blunt trauma
• Eye pain, especially if not relieved by topical anesthetic[3]

Symptoms

• 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]

Complications:

• 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]

• 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

• Red eye
• Eye pain