Traumatic Iritis

Symptoms

Dull, aching, or throbbing pain, photophobia, tearing, occasionally floaters, and onset of symptoms usually within 1 to 3 days of trauma.

Signs

Critical

White blood cells (WBCs) and flare in the AC (seen under high-power magnification by focusing into the AC with a small, bright, tangential beam from the slit lamp).

Other

Pain in the traumatized eye when light enters either eye (consensual photophobia); lower (due to ciliary body shock/shutdown) or higher (due to inflammatory debris and/or trabeculitis) IOP than fellow eye; smaller, poorly dilating pupil or larger pupil (often due to iris sphincter tears) in the traumatized eye; perilimbal conjunctival injection; decreased vision.

Differential Diagnosis

Nongranulomatous anterior uveitis: No history of trauma, or the degree of trauma is not consistent with the level of inflammation. See 12.1, ANTERIOR UVEITIS (IRITIS/IRIDOCYCLITIS).
Traumatic microhyphema or hyphema: Red blood cells (RBCs) in the AC. See 3.6, HYPHEMA AND MICROHYPHEMA.
Traumatic corneal abrasion: May have an accompanying sterile AC reaction. See 3.2, CORNEAL ABRASION.
Traumatic retinal detachment: May produce an AC reaction or demonstrate pigment in the anterior vitreous. See 11.3, RETINAL DETACHMENT.

Workup

Complete ophthalmic examination, including IOP measurement and dilated fundus examination.

Treatment

Cycloplegic agent (e.g., cyclopentolate 1% or 2% b.i.d. to t.i.d.). May use a steroid drop (e.g., prednisolone acetate 0.125% to 1% q.i.d.). Avoid topical steroids if an epithelial defect is present.

Follow Up

Recheck in 5 to 7 days.
If resolved, discontinue the cycloplegic agent and taper steroid drops if using.
Around 1 month after trauma, perform gonioscopy to look for angle recession and indirect ophthalmoscopy with scleral depression to detect retinal breaks or detachment.

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