Iritis (Uveitis)

Question 1

What are the types of uveitis? (4)

Answer 1

1. Anterior Uveitis - inflammation of iris and ciliary body (anterior uvea).
2. Intermediate Uveitis - inflammation of vitreous humour, characterised by ‘snowballs’ and ‘snow banking’ on fundoscopy.
3. Posterior Uveitis - inflammation of the choroid.
4. Panuveitis - all of the above combined.

Question 2

What is the uvea made up of?

Answer 2

1. Iris.
2. Ciliary Body.
3. Choroid (layer between retina and sclera).

Question 3

What is iritis?

Answer 3

Anterior uveitis - infiltration of anterior chamber by neutrophils, lymphocytes and macrophages.

Question 4

CHRONIC IRITIS vs. Acute Iritis (3).

Answer 4

1. More granulomatous (more macrophages).
2. Less severe.
3. Longer duration of symptoms lasting more than 3 months.

Question 5

Association of Acute Iritis.

Answer 5

HLA-B27 Related Conditions e.g. Ankylosing Spondylitis, Inflammatory Bowel Disease and Reactive Arthritis (AIR).

Question 6

Associations of Chronic Iritis (5).

Answer 6

1. Sarcoidosis (Bilateral Disease).
2. Syphilis.
3. Lyme disease.
4. Tuberculosis.
5. Herpes Virus.

Question 7

Aetiology of Iritis.

Answer 7

Autoimmune process, but can be due to infection, trauma, ischaemia or malignancy.

Question 8

Clinical Features of Iritis (8).

Answer 8

1. Floaters & Flashes.
2. Dull Aching Red Eye (& Pain when moving eye).
3. Ciliary Flush.
4. Miosis.
5. Photophobia.
6. Lacrimation.
7. Abnormally Shaped Pupil.
8. Hypopyon.

Question 9

What are Floaters due to?

Answer 9

Inflammatory cells in the anterior chamber.

Question 10

What is Ciliary Flush?

Answer 10

A ring of red spreading from the cornea outwards.

Question 11

What is Miosis due to?

Answer 11

Sphincter Muscle Contraction.

Question 12

What is Photophobia due to?

Answer 12

Ciliary Muscle Spasm.

Question 13

What is the Abnormally Shaped Pupil due to?

Answer 13

Posterior Synechiae (Adhesions) pulling the iris into shapes.

Question 14

What is Hypopynon?

Answer 14

A collection of White Blood Cells in the Anterior Chamber - a yellowish collection settled in front of the lower iris, with a fluid level.

Question 15

Investigations of Iritis (2).

Answer 15

1. Any patient with a red eye and suspected potentially sight-threatening cause should be referred for same day assessment by an ophthalmologist.
2. Full Slit-Lamp Assessment and IOP measurements.

Question 16

Management of Iritis (3).

Answer 16

1. Steroids and Immunosuppressants.
2. Cycloplegic Mydriatic Medications.
3. Laser Therapy, Cryotherapy, Surgery (Vitrectomy) in Severe Cases.

Question 17

Give 2 examples of Cycloplegic Mydriatic medications.

Answer 17

1. Cyclopentolate.

2. Atropine.

Question 18

What is a Cycloplegic Mydriatic Medication?

Answer 18

Cycloplegic - paralysis of ciliary muscles.

Mydriatic - dilating the pupils.

Question 19

Mechanism of Action of Cycloplegic Mydriatic Medications (3).

Answer 19

1. Antimuscarinic drugs.
2. Block the action of the iris sphincter muscles and ciliary body to dilate the pupil.
3. Stop action of ciliary body to reduce pain associated with ciliary spasm.