Uveitis/Iritis 

inflammation of the uveal tract.

• Eye redness
  • around edge of iris/ ciliary flush – however conjunctivae can be injected too. 
  • Won’t extend onto eyelid conjunctiva though
• Eye discomfort/pain
  •  can radiate to brow/temple/nose due to trigeminal nerve irritation
• Lacrimation 
• Blurred vision
• photophobic
• Iritis
  • Irregular of Small pupil frpm posterior synechiae- iris sticks to lens, pupil can become small due to adhesions

History

• Anterior uveitis:
  • Painful red eye
    • deep ache radiating to periorbital or temple area, worse with movement and accommodation.
  • photophobia
  • +/- blurred vision
• Posterior uveitis —
  • “floaters” and visual changes — blind spots or flashes may be present with retinal involvement.
  • Redness or significant pain are usually absent.
  • Features of an underlying cause (see Q2) — inflammatory (HLA-B27 vs non-HLA-B27 associated conditions), infectious traumatic, or drugs.
• Duration and previous episodes?

• Examination
  • Cells in anterior chamber +/- hypopion

• Causes
  • Seronegative arthropathies
    • AS
  • SLE
  • IBD
  • Sarcoidoisis
  • infections – toxoplasmosis, syphilis
  • Ensure no recent eye surgery – emergency

Investigations may not be required if:

• known underlying cause (e.g. sarcoidosis or drugs)
• mild unilateral nongranulomatous disease with no evidence of systemic disease

Complications 

• cataracts
• glaucoma (e.g. due to synechiae)
• retinal detachment
• ophthalmitis

Management

• Urgent referral to ophthalmology.
• Seek and treat underlying causes.
• Treat complications
  • glaucoma
• Mydriatics
  • (eg, sympathomimetics like phenylephrine HCl) — prevent the formation of synechiae by pupillary dilation.
• Parasympatholytic agents
  • (eg, atropine, cyclopentolate) — produce both mydriasis and cycloplegia reducing pain and photophobia
• Treat with corticosteroids
• All cases of uveitis should be discussed with an ophthalmologist.
  • Uncomplicated noninfectious uveitis — outpatient management with ophthalmology follow up within 24 hours.
  • Refractory or infectious uveitis — usually require admission and further work up.