Iritis Overview for Medical Practitioners

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Questions and Answers

What is a characteristic symptom of conjunctivitis?

Deep visceral pain

Pupil mid-dilated and non-reactive

Preauricular lymph node swelling (correct)

Unilateral eye redness only

Which symptom differentiates a foreign body sensation from an actual foreign body in the eye?

Presence of opacification

Localized redness around corneal area

Circumcorneal injection

Absence of actual foreign body (correct)

What is the typical pupil reaction observed in acute angle closure glaucoma?

Constricted and reactive

Mid-dilated and non-reactive (correct)

Normal and reactive

Dilated and reactive

In which condition are circumcorneal vessels typically normal?

Conjunctivitis Signup and view all the answers

What is a notable sign of corneal ulcers compared to iritis?

Corneal opacification Signup and view all the answers

Which ocular condition is most likely to lead to nausea?

Acute angle closure glaucoma Signup and view all the answers

What differentiates herpes keratitis from iritis in terms of pupil reaction?

Pupil is usually normal Signup and view all the answers

A patient with a foreign body in the eye is likely to experience which type of discomfort?

Instant discomfort worsening with eye movement Signup and view all the answers

What are the common symptoms of iritis?

Watery red eye, pain, photophobia Signup and view all the answers

What ocular sign is typically associated with iritis?

Circumcorneal injection Signup and view all the answers

Which condition is NOT commonly associated with systemic illness in patients with iritis?

Systemic lupus erythematosus Signup and view all the answers

What is typically observed during the examination of a patient with iritis?

Clear cornea with a small pupil Signup and view all the answers

How should vision be tested in a patient suspected of having iritis?

In a darkened room to reduce discomfort Signup and view all the answers

What is a sign of posterior synechiae in a patient with iritis?

Irregularities of the dilated pupil Signup and view all the answers

What might patients do to alleviate symptoms of pain associated with iritis?

Keep their eyes closed or wear sunglasses Signup and view all the answers

What is the typical time frame for the onset of symptoms in patients with iritis?

Over 24 to 48 hours Signup and view all the answers

Study Notes

Iritis

Iritis is a common intraocular inflammation, often causing a red eye.
GPs should consider this diagnosis in any patient with a red eye.
History: Many patients with iritis have had it before, and experience symptoms before noticeable signs. This recurring pattern is key. Principal symptoms include a watery, red eye, pain (deep and dull), and photophobia (light sensitivity) which usually develops over 24-48 hours. Patients with iritis often keep their eyes closed or wear sunglasses.. Vision is usually mildly decreased.
Medical history is important: About 10% of iritis patients have a systemic condition. Specifically inquire about conditions like ankylosing spondylitis, inflammatory bowel disease, tuberculosis, and sarcoidosis.
Examination:
- Vision: Assessing vision can be difficult due to photophobia. Testing in a darkened room or after pupil dilation often improves results.
- Eye: Redness is typically concentrated at the limbus (ciliary or circumcorneal injection) which overlies the inflamed iris. The cornea is usually clear, and the pupil is frequently small unless prevented by synechiae (adhesions).
- Dilated examination: Dilating the pupil is helpful. Look for posterior synechia (adhesions between the iris and the lens surface) as signs of previous or current iritis. Keratic precipitates (inflammatory cell deposits on the corneal endothelium) can sometimes be seen against the red reflex from a dilated pupil during examination.

Differential Diagnosis

Foreign Body: Foreign bodies usually cause immediate, worsening discomfort with blinking. There's no circumcorneal injection (redness around the cornea's edge), but redness may be localized near the foreign body. Be aware of patients describing foreign body sensation without a visible foreign body.
Conjunctivitis: Generally bilateral. Visual changes are less pronounced in conjunctivitis, and blood vessel engorgement is usually more prominent in the conjunctival fornix. It is commonly associated with upper respiratory infections and preauricular lymph node swelling.
Herpes Keratitis: Patients typically present with a history of ocular herpes. The eye is visibly more pink-red than in typical iritis. The pupil is usually normal, but a fluorescein stain can reveal an ulcer in the cornea.
Acute Angle-Closure Glaucoma: This condition affects mostly the elderly. Deep, visceral pain, mid-dilated and unresponsive pupils, a cloudy cornea, and poor vision are common, along with possible nausea. The affected eye is hard, when palpated.
Corneal Ulcer: Main sign is corneal opacity. Hypopyon (pus in the front of the eye) is more common than in iritis.

When to Refer

All patients with iritis should be referred to an ophthalmologist.
Recurrent iritis patients can be started on treatment in consultation with an ophthalmologist but should be reviewed within 48 hours.

Key Points

Suspect iritis in any patient with a unilateral red eye.
A history of previous iritis plus symptoms or signs of eye inflammation strongly suggests a recurrence until proven otherwise.
Cardinal signs of iritis include a watery eye, peri-corneal injection, pinpoint pupils, photophobia, and mild visual loss.

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Description

This quiz covers the key aspects of iritis, a common intraocular inflammation leading to red eye symptoms. It emphasizes the importance of medical history and the typical examination process, highlighting systemic conditions that may be associated with iritis. Understand the principal symptoms and diagnostic considerations critical for general practitioners.