Iritis: Symptoms, Causes, Treatment

What are the symptoms of iritis?

Iritis, also known as anterior uveitis, is inflammation of the iris (the colored part of the eye). Symptoms typically develop suddenly and can affect one or both eyes. Common symptoms of iritis include:

Eye pain: Often described as a deep, aching pain in or around the eye.
Redness: The eye may become red, particularly around the iris.
Light sensitivity (photophobia): Discomfort or pain when exposed to bright light.
Blurred vision: Vision may become cloudy or blurry.
Decreased vision: Loss of visual clarity or sharpness.
Tearing: Excessive tearing or watery eyes.
Small or irregularly shaped pupil: The pupil may appear smaller than normal or react differently to light.

If left untreated, iritis can lead to complications like glaucoma, cataracts, or vision loss, so prompt treatment by an eye specialist is important.

What are the causes of iritis?

Iritis, or anterior uveitis, can be caused by a variety of factors. In many cases, the exact cause is unknown, but common causes include:

1. Autoimmune and Inflammatory Diseases

Ankylosing spondylitis: A form of arthritis that primarily affects the spine.
Rheumatoid arthritis: A chronic inflammatory disorder affecting the joints.
Sarcoidosis: An inflammatory disease affecting various organs, including the eyes.
Lupus: An autoimmune disease affecting multiple systems.
Inflammatory bowel diseases: Such as Crohn’s disease or ulcerative colitis.

2. Infections

Herpes simplex or herpes zoster (shingles): Viral infections can cause inflammation of the eye.
Tuberculosis: A bacterial infection that can lead to iritis.
Syphilis: A sexually transmitted bacterial infection that can affect the eyes.
Lyme disease: A tick-borne illness that can cause eye inflammation.

3. Trauma or Injury

Eye injury: Blunt force trauma to the eye or surrounding areas can lead to iritis.
Surgery: Previous eye surgery or procedures can sometimes trigger iritis.

4. Genetic Factors

HLA-B27: A genetic marker associated with an increased risk of developing autoimmune diseases like ankylosing spondylitis and reactive arthritis, which can lead to iritis.

5. Medications

Certain drugs: Some medications, particularly bisphosphonates (used for osteoporosis) and certain antibiotics, have been linked to iritis as a side effect.

6. Idiopathic

In many cases, no specific cause can be identified. This is referred to as idiopathic iritis.

Prompt treatment is important, regardless of the cause, to prevent complications like glaucoma or vision loss.

What is the treatment for iritis?

The treatment for iritis (anterior uveitis) depends on the underlying cause and the severity of the inflammation. The main goals are to reduce inflammation, alleviate pain, and prevent complications such as vision loss or glaucoma. Common treatments include:

1. Corticosteroid Eye Drops

Topical steroids (e.g., prednisolone) are often the first line of treatment to reduce inflammation in the eye. These drops are used frequently at first and then tapered as the inflammation subsides.

2. Dilating Eye Drops

Cycloplegic eye drops (e.g., atropine or cyclopentolate) are used to:
Relieve pain by relaxing the muscles in the iris.
Dilate the pupil to prevent it from sticking to the lens (posterior synechiae).
Reduce light sensitivity.

3. Oral Corticosteroids

In cases where eye drops alone are not sufficient, oral steroids (e.g., prednisone) may be prescribed to treat more severe or resistant inflammation.

4. Immunosuppressive Medications

If iritis is linked to an autoimmune condition or if corticosteroids are not effective, immunosuppressive drugs (e.g., methotrexate or azathioprine) may be used to control the immune system’s activity.

5. Antibiotics or Antivirals

If an infection (e.g., herpes simplex, tuberculosis, or syphilis) is the cause, appropriate antibiotic or antiviral medications will be prescribed to treat the underlying infection.

6. Treating Underlying Conditions

Management of systemic diseases: If iritis is associated with conditions like rheumatoid arthritis, sarcoidosis, or ankylosing spondylitis, treatment of the underlying disease is critical to controlling inflammation in the eye.

7. Monitoring and Follow-up

Regular follow-ups with an ophthalmologist are necessary to monitor the response to treatment and to check for complications such as increased eye pressure (glaucoma) or cataracts, which can be side effects of prolonged steroid use.

8. Surgical Intervention

Surgery is rare but may be necessary in cases where complications like cataracts or glaucoma develop due to chronic iritis.

Early and effective treatment of iritis is important to prevent long-term damage to the eye and maintain good vision.