Iris is a circular pigmented portion which imparts colour to the eye and provides opening for the light to enter. It controls the amount of light which enters the eye through the pupil. It makes the pupil smaller in size in the presence of bright light and it enlarges the pupil in dim light. However, under some conditions iris gets inflamed and is called as Iritis. Traumatic iritis is a condition which happens due to trauma or injury or a blunt blow to the iris. It is a subtype of uveitis of nature anterior uveitis.
Symptoms of Traumatic Iritis
Initially when traumatic iritis occurs for 2-3 days, it is asymptomatic. Then it shows symptoms such as:
- Pain in the affected eye
- Sensitivity to the exposed light
- Blurring of the vision
- Floating cells and protein in the anterior chamber liquid which are released from inflamed blood vessels
- Leukocytic exudate in the anterior chamber liquid.
Epidemiology of Traumatic Iritis
Traumatic iritis accounts for 20% of all uveitis. It occurs more in men than in women. Young people are found to suffer more often from traumatic iritis as compared to the elderly people.
Prognosis of Traumatic Iritis
When the traumatic blow causing iritis is mild and is immediately considered for medical treatment, then such patients with traumatic iritis respond very well to the standard treatments. However, in case of a major blow and/or treatment is delayed, the prognosis for traumatic iritis may not be good and it may result in blindness.
Causes and Risk Factors of Traumatic Iritis
Pathophysiology of Traumatic Iritis
The necrotic products are formed from the trauma that causes injury and death of the eye cells. These necrotic products stimulate an inflammatory reaction due to which white blood cells come to this area to repair the injury and increase the healing process. The inflamed cells make it sticky inside the eye and causes part of the iris and other parts to stick together which causes further damage. There is increased permeability of blood vessels in the eye which enable the inflammatory cells and mediators and other protein contents to enter the eye and cause more damage. Also aqueous humor fills up with these cells and proteins which cause it to thicken even more. This thick or highly viscous liquid cannot get filtered and causes eye pressure to increase to dangerous levels. While at times, the ciliary body is traumatized and causes reduction in eye pressure.
Complications of Traumatic Iritis
Complications of traumatic Iritis include:
- Decreased vision
- Loss of vision or blindness
- Change in the size of the pupil
- Band keratopathy
- Macular edema
- Retinal detachment or retinal tear.
Diagnosis of Traumatic Iritis
The doctor records the medical history and thoroughly examines the eyes. The doctor checks for:
- Visual acuity
- Measure the pressure inside the eye and the anterior part of the eye with slit lamp biomicroscope.
- The presence of inflammatory cells and proteins floating in the fluid in the front part of the eye.
- Pupils are tested; the pupil is dilated to view the optic nerve, blood vessels and retina.
Treatment of Traumatic Iritis
The treatment for traumatic iritis includes:
- Topical cycloplegics to dilate the pupil. They stabilize the blood-aqueous barrier to prevent lens protein leakage. They also prevent ciliary body and papillary spasm that causes pain and discomfort.
- Topical steroids (such as prednisolone) to treat traumatic iritis are used to decrease inflammation associated with traumatic iritis.
- Topical beta-blockers for traumatic iritis are useful when there is secondary glaucoma present.
- Pain associated with traumatic iritis is reduced by taking analgesics (acetaminophen) to control discomfort.
- Using dark spectacles to limit exposure of eyes to harsh lights.
Prevention of Traumatic Iritis
It may not be possible to always avoid traumatic iritis. However, it is suggested that one can wear a protective eye wear during sports activities to prevent traumatic iritis.
Traumatic iritis results due to inflammation caused by the blunt blow to the iris. If the extent of damage is diagnosed early, then it shows good prognosis with standard treatments. However, if traumatic iritis is not treated immediately, then it may result in loss of vision. Hence, any trauma, injury or blow to the eye must be taken seriously and immediate medical advice must be taken without any delay.