Key Signs and Symptoms of Iritis
Iritis presents with a classic triad of eye redness, eye pain (with or without aching discomfort), and photophobia, often accompanied by blurred vision. 1, 2, 3, 4
Cardinal Symptoms
- Eye redness: A prominent feature that distinguishes iritis from other ocular conditions 1
- Eye pain: Ranges from aching discomfort to severe pain, often worsening with eye movement 1, 4
- Photophobia (light sensitivity): Patients experience significant discomfort in bright light 1, 5, 4
- Blurred vision: Visual acuity may be reduced during acute episodes 1, 2
Clinical Presentation Patterns in Systemic Disease
In patients with ankylosing spondylitis, reactive arthritis, or inflammatory bowel disease, iritis typically follows a specific phenotype:
- Sudden onset of symptoms rather than gradual development 6
- Unilateral presentation (affecting one eye at a time) 6
- Recurrent episodes with symptom-free intervals between attacks 1, 6
- More common in males with HLA-B27 associated conditions 6
This contrasts with psoriatic arthritis or inflammatory bowel disease-associated uveitis, which more often presents with insidious onset, bilateral involvement, and chronic course. 6
Warning Signs Requiring Urgent Evaluation
All patients with suspected acute iritis require urgent ophthalmology evaluation within 24-48 hours to prevent vision-threatening complications including glaucoma, cataracts, and permanent vision loss. 1, 2, 3
Patients with systemic inflammatory conditions (ankylosing spondylitis, reactive arthritis, inflammatory bowel disease) should be educated about these warning signs to enable prompt self-recognition and treatment initiation. 1, 5
Clinical Examination Findings
While symptoms guide initial suspicion, ophthalmologic examination reveals:
- Anterior chamber inflammation with cells and flare visible on slit-lamp examination 2, 3
- Ciliary flush (circumcorneal injection) 4
- Miosis (constricted pupil) due to ciliary muscle spasm 4
- Posterior synechiae (iris adhesions to lens) in severe or chronic cases, indicating poor prognosis 2
Common Pitfalls in Recognition
Morning stiffness and nocturnal symptoms are characteristic of the underlying systemic inflammatory conditions but not specific to iritis itself. 5 The key is recognizing the acute ocular symptoms (redness, pain, photophobia) superimposed on chronic systemic disease. 1
Patients with recurrent iritis should receive prescriptions for topical corticosteroids (prednisolone acetate 1%) for prompt at-home initiation when typical symptoms develop, followed by urgent ophthalmology follow-up within 24-48 hours. 1, 2, 3 This approach decreases episode severity, duration, and likelihood of ocular complications. 1, 2