What is Iritis?
Iritis is inflammation of the iris (the colored part of the eye) and represents a form of anterior uveitis—inflammation affecting the front structures of the eye including the iris and/or ciliary body.
Clinical Definition and Presentation
Iritis is not a disease itself but rather a sign of an underlying condition that can be infectious, autoimmune, traumatic, or idiopathic 1, 2. The condition manifests with characteristic symptoms that distinguish it from benign causes of red eye:
- Eye pain and aching discomfort
- Photophobia (light sensitivity)
- Decreased visual acuity
- Red eye
These symptoms, particularly when occurring together, should raise immediate clinical suspicion and warrant urgent ophthalmologic evaluation 1, 3.
Types and Classification
Iritis can be classified based on:
Clinical Significance
Iritis is a potentially sight-threatening condition that requires immediate recognition and treatment 1. If left undiagnosed or improperly treated, it can lead to serious complications including:
- Glaucoma (elevated intraocular pressure)
- Cataract formation (particularly with prolonged topical steroid use)
- Posterior synechiae (adhesions between iris and lens)
- Macular edema
- Vision loss 3, 7
Diagnostic Approach
Diagnosis requires slit-lamp examination by an ophthalmologist or skilled examiner 1. The evaluation should identify:
- Location and severity of inflammation
- Presence of cells and flare in the anterior chamber
- Associated complications (synechiae, elevated pressure, lens changes)
Context-Specific Considerations
In Juvenile Idiopathic Arthritis (JIA)
Chronic anterior uveitis (CAU) in children with JIA is often asymptomatic initially, making regular screening essential 5. This differs from acute anterior uveitis (AAU) seen in spondyloarthritis.
In Spondyloarthritis
AAU typically presents with acute symptoms (eye pain, redness, photophobia) in HLA-B27 positive patients with enthesitis-related arthritis 4. Patient education about warning signs is critical to prevent delays in treatment.
Post-Traumatic
Most commonly affects younger males and occurs unilaterally, with sports, assault, and work-related injuries being the most frequent mechanisms 6.
Treatment Principles
First-line treatment involves topical corticosteroids (prednisolone or dexamethasone) combined with mydriatic and cycloplegic agents 5, 1. However, prolonged or high-dose topical steroid use carries significant risks, necessitating close monitoring and consideration of systemic immunosuppression when topical therapy is insufficient 5.