anterior uveitis (iritis, iridocyclitis)
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Introduction
Inflammation involving the ciliary body & iris.
Classification
- iritis: inflammation of the iris
- iridocyclitis: inflammation of the iris & ciliary body
Etiology
- sarcoidosis
- ankylosing spondylitis
- juvenile rheumatoid arthritis
- inflammatory bowel disease
- psoriasis
- Reiter's syndrome
- Behcet's disease
- Herpes infection
- syphilis
- Lyme disease (generally not associated with uveitis)[6]
- onchocerciasis
- tuberculosis
- leprosy
- post-traumatic, blunt trauma (may develop 2-3 days after injury)[7]
- idiopathic
Pathology
- may be associated with autoantibodies to UACA
- may be associated with autoantibodies to TRIB2
Clinical manifestations
- ocular pain
- photophobia (often extreme)*
- blurred vision
- injection (redness) in the limbus area
- deposits in the cornea
- red eye: redness around the cornea (ciliary flush)
- irregular pupil, miosis
- pain elicited in the affected eye by the consensual light reflex
- pupil remains small, does not dilate in response to swinging flashlight
- may be unilateral or bilateral
- may develop 2-3 days after injury[7]
- recurrences are common[7]
* key feature[7]
Laboratory
- slit lamp examination to identify inflammatory cells on the corneal epithelium or in the aqueous humor
Differential diagnosis
- corneal abrasion
- symptoms apparent immediately after trauma
- foreign body sensation
- traumatic optic neuropathy
- severe facial trauma as from motor vehicle accident
- afferent pupillary defect
- hyphema
Management
- therapy aimed at reducing intraocular pressure[4]
- topical steroids - prednisolone (Pred Forte)
- mydriatic/cycloplegic agent such as cyclopentolate
- dilation of the pupil reduces pain & prevents formation of synechiae
- cycloplegia reduces pain by relaxing the ciliary muscle[7]
- treat underlying disorder
- referral to an ophthalmologist[4]
More general terms
More specific terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 69-71
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 165
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 5.0 5.1 NEJM Knowledge+. Question of the Week. Aug 9, 2016 http://knowledgeplus.nejm.org/question-of-week/1519/
- ↑ 6.0 6.1 NEJM Knowledge+ Rheumatology
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 NEJM Knowledge+ Ophthalmology