Iritis

Disease Description (Causes and Symptoms)

• Definition: Iritis is inflammation of the iris. Because the adjacent ciliary body often becomes inflamed together with the iris, it is commonly referred to as anterior uveitis (iridocyclitis).
• Causes
  • Exogenous: Ocular trauma, infection after surgery, or mechanical irritation
  • Endogenous: Infection (viral, bacterial, or fungal), systemic autoimmune diseases (e.g., HLA-B27-associated diseases such as ankylosing spondylitis, rheumatoid diseases, etc.), metabolic diseases (such as diabetes), and immune abnormalities
  • Clinically, more than 50% of cases are classified as having an unknown cause (idiopathic)
  • May occur when inflammation spreads from surrounding tissues (the cornea or sclera)
• Pathophysiology: Inflammatory cells infiltrate the blood vessels and stroma of the iris and ciliary body, increasing cells and protein (flare) in the anterior chamber, and causing reduced pupillary response and adhesions (posterior synechiae), among other changes. If the inflammation becomes chronic, it may cause fibrosis, adhesions, glaucoma, or cataracts.
• Main symptoms
  • Photophobia (light sensitivity), tearing, eye pain (dull or aching pain in severe cases), and redness (especially ciliary injection or circumcorneal injection)
  • Decreased or blurred vision, sluggish pupillary response, and epiphora (tearing/discharge)
  • Examination findings: Cells and protein (flare) in the anterior chamber, keratic precipitates on the posterior surface of the cornea, posterior synechiae, and other findings may be identified with a slit-lamp examination

Treatment Methods

• Goals: Control inflammation, relieve pain, prevent adhesions and complications (such as glaucoma and cataracts), and treat the underlying disease
• Medication treatment
  • Topical steroid eye drops (e.g., prednisolone) — Typical first-line treatment; frequency is adjusted according to the severity of inflammation
  • Mydriatics and cycloplegics (e.g., atropine and cyclopentolate) — Prevent pupillary adhesions and reduce pain
  • Systemic steroids or immunosuppressants when necessary (in chronic or severe cases or when associated with systemic disease)
  • If an underlying infection is suspected, the appropriate antimicrobial agent (antiviral, antibiotic, or antifungal) may be used in combination
• Procedures/Surgery
  • Ophthalmic procedures or surgery may be considered in cases of severe complications (uncontrollable glaucoma, severe adhesions, etc.)
• Lifestyle management and precautions
  • Use prescribed eye drops regularly and do not stop them on your own (especially steroids)
  • Wearing sunglasses in sunlight (when experiencing light sensitivity) may relieve symptoms
  • Contact lens users should refrain from wearing them until instructed by a doctor
  • Because steroid use carries a risk of increased intraocular pressure and cataracts, regular intraocular pressure measurements and eye examinations are required
• Complications
  • Sequelae: Residual adhesion (optic nerve), posterior synechiae, secondary glaucoma, cataracts, and corneal opacity
  • The risk of blindness increases if treatment is delayed
• Prognosis
  • Most cases can improve with prompt diagnosis and treatment; however, recurrent or chronic inflammation increases the rate of complications

Checklist Before an Outpatient Visit (Items to Prepare, Records, and Example Questions)

• Items/documents to prepare or bring
  • A list of currently used medications (including eye drops) and the times they are taken
  • Records of previous eye surgery, trauma, or diagnoses (if possible)
  • A record of recent changes in vision (when they began and to what extent) and the pattern of pain (intensity and time of day)
  • Allergy history, systemic diseases (rheumatoid disease, tuberculosis, diabetes, etc.), and related test results (if available)
  • Whether you use contact lenses and your occupation and lifestyle (such as work that involves touching the eyes)
• Information to tell the doctor in advance during the outpatient visit
  • When the symptoms began and how they have progressed
  • Whether you have had a recent infection (fever, rash, urinary symptoms, etc.) or any systemic symptoms
• Examples of questions to ask before the outpatient visit
  • “Please let me know if you are currently taking any medications, especially immunosuppressants or steroids.”
  • “Please record the degree of vision loss since the symptoms began and bring it with you (for example, changes in vision by date).”

Examples of General Questions to Ask the Doctor

• What side effects are expected with this medication, and what signs should be monitored?
• How long will treatment take, and how will the frequency of eye-drop use be adjusted?
• How often should I have regular checkups (intraocular pressure measurement and slit-lamp examination)?
• How likely is this disease to lead to blindness, and what complications should I watch for?

Examples of Disease-Specific Questions

• What tests should I undergo to determine whether my iritis is associated with a systemic disease (e.g., an HLA-B27-associated disease, tuberculosis, syphilis, sarcoidosis, etc.)?
• There is a risk of increased intraocular pressure while using steroids. How will it be managed if my intraocular pressure rises (such as changing medications or receiving glaucoma treatment)?