Traumatic iritis - Revision history

ClaireLewis at 15:31, 5 October 2019

2019-10-05T15:31:48Z

← Older revision		Revision as of 15:31, 5 October 2019
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	==Background==		==Background==
	*Classically blunt trauma: contusion and spasm of ciliary body and iris		*Classically blunt [[ocular Trauma\|trauma]]: contusion and spasm of ciliary body and iris
	*May occur in any traumatic injury<ref>Augsburger JJ, Corrêa ZM. Chapter 19. Ophthalmic Trauma. In: Riordan-Eva P, Cunningham, Jr. ET, eds. Vaughan &amp;amp;amp;amp;amp; Asbury's General Ophthalmology. 18th ed. New York, NY: McGraw-Hill; 2011:371-382.</ref>		*May occur in any traumatic injury<ref>Augsburger JJ, Corrêa ZM. Chapter 19. Ophthalmic Trauma. In: Riordan-Eva P, Cunningham, Jr. ET, eds. Vaughan &amp;amp;amp;amp;amp; Asbury's General Ophthalmology. 18th ed. New York, NY: McGraw-Hill; 2011:371-382.</ref>
	*90% of uveitis is iritis, and traumatic iritis accounts for 20% of iritis<ref>Gutteridge IF, Hall AJ. Acute anterior uveitis in primary care. Clinical and Experimental Optometry. 2007. 90(2):70-82.</ref>		*90% of uveitis is iritis, and traumatic iritis accounts for 20% of iritis<ref>Gutteridge IF, Hall AJ. Acute anterior uveitis in primary care. Clinical and Experimental Optometry. 2007. 90(2):70-82.</ref>

	==Clinical Features==		==Clinical Features==
	*Often delayed presentation after traumatic event, typically within 3 days of blunt trauma		*Often delayed presentation after traumatic event, typically within 3 days of blunt [[ocular Trauma\|trauma]]
	*[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref>		*[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref>
	Symptoms		Symptoms
	*Blurry vision in affected eye		*[[blurred vision\|Blurry vision]] in affected eye
	*Photophobia		*Photophobia
	*Floaters		*[[Floaters]]
	*Tearing		*Tearing
			*Perilimbal conjunctival injection, ciliary flush
	~~Signs~~		*[[Vision loss\|Decreased visual acuity]]
	*~~perilimbal~~ conjunctival injection, ciliary flush		*Sluggish pupil affected eye
	*~~decreased~~ visual acuity		*Hallmark findings of consensual photophobia and “cell and flare” (anterior chamber) on slit limp examination
	*~~sluggish~~ pupil affected eye
	* ~~hallmark~~ findings of consensual photophobia and “cell and flare” (anterior chamber) on slit limp examination
	**“Cell:” individual cells floating in the anterior chamber (look like dust specks)		**“Cell:” individual cells floating in the anterior chamber (look like dust specks)
	**“Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke)		**“Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke)
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	**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref>		**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref>
	Complications:		Complications:
	*~~synechiae~~ formation		*Synechiae formation
	*Vossius' ring on anterior lens capsule		*Vossius' ring on anterior lens capsule
	**Due to concussive force of posterior iris onto lens		**Due to concussive force of posterior iris onto lens
	**Depositing pigment in the pattern of a miosed pupil onto anterior lens		**Depositing pigment in the pattern of a miosed pupil onto anterior lens
	*IOP may be increased due to inflammation, damage to ciliary body, or circumferential synechial formation<ref>Trevor-Roper PD, Curran PV. The Eye and Its Disorders. Boston, MA: Blackwell Scientific Publications; 1984:489-507.</ref>		*[[IOP]] may be increased due to inflammation, damage to ciliary body, or circumferential synechial formation<ref>Trevor-Roper PD, Curran PV. The Eye and Its Disorders. Boston, MA: Blackwell Scientific Publications; 1984:489-507.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

Ekaduke12: /* Clinical Features */

2019-10-04T07:27:18Z

Clinical Features

← Older revision		Revision as of 07:27, 4 October 2019
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	*[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref>		*[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref>
	Symptoms		Symptoms
	*~~Decreased visual acuity~~ in affected eye		*Blurry vision in affected eye
	*Photophobia		*Photophobia
	*Floaters		*Floaters

Ekaduke12: /* Clinical Features */

2019-10-04T07:25:43Z

Clinical Features

← Older revision		Revision as of 07:25, 4 October 2019
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	Signs		Signs
	*perilimbal conjunctival injection		*perilimbal conjunctival injection, ciliary flush
	*decreased visual acuity		*decreased visual acuity
	*sluggish pupil affected eye		*sluggish pupil affected eye

Ekaduke12: /* Clinical Features */

2019-10-04T07:24:50Z

Clinical Features

← Older revision		Revision as of 07:24, 4 October 2019
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	*[[Hypopyon]] (severe cases): leukocytic exudate in anterior chamber		*[[Hypopyon]] (severe cases): leukocytic exudate in anterior chamber
	**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref>		**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref>
			Complications:
			*synechiae formation
	*Vossius' ring on anterior lens capsule		*Vossius' ring on anterior lens capsule
	**Due to concussive force of posterior iris onto lens		**Due to concussive force of posterior iris onto lens

Ekaduke12: /* Clinical Features */

2019-10-04T07:23:15Z

Clinical Features

← Older revision		Revision as of 07:23, 4 October 2019
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	==Clinical Features==		==Clinical Features==
	*Often delayed presentation after traumatic event, typically ~~24-48 hrs~~		*Often delayed presentation after traumatic event, typically within 3 days of blunt trauma
	*[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref>		*[[Eye pain]], especially if not relieved by topical anesthetic<ref>Reidy JJ. Section 08: External Disease and Cornea. Basic and Clinical Science Course. San Francisco, CA: American Academy of Ophthalmology; 2012: 363.</ref>
			Symptoms
	*Decreased visual acuity in affected eye		*Decreased visual acuity in affected eye
	*Photophobia ~~(direct and consensual)~~		*Photophobia
	*~~Sluggish pupil~~		*Floaters
	*~~[[Hypopyon]] (severe cases): leukocytic exudate in anterior chamber~~		*Tearing
	*~~Cell & flare~~ (anterior chamber ~~reaction~~)
			Signs
			*perilimbal conjunctival injection
			*decreased visual acuity
			*sluggish pupil affected eye
			* hallmark findings of consensual photophobia and “cell and flare” (anterior chamber) on slit limp examination
	**“Cell:” individual cells floating in the anterior chamber (look like dust specks)		**“Cell:” individual cells floating in the anterior chamber (look like dust specks)
	**“Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke)		**“Flare:" protein floating in the anterior chamber from inflamed blood vessels. (smoke)
			*[[Hypopyon]] (severe cases): leukocytic exudate in anterior chamber
	**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref>		**May deposit onto corneal endothelium as keratic precipitates<ref>Bartley GB, Liesegang TJ. Essentials of Ophthalmology. Philadelphia, PA: JB Lippincott Company; 1992:156-157.</ref>
	*Vossius' ring on anterior lens capsule		*Vossius' ring on anterior lens capsule

ClaireLewis: /* Management */

2019-09-24T04:11:41Z

Management

← Older revision		Revision as of 04:11, 24 September 2019
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	==Management==		==Management==
	#PO analgesia		#PO [[analgesia]]
	#[[Cycloplegic]]s paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.</ref>		#[[Cycloplegic]]s paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.</ref>
	##[[Homatropine]] 5% BID-TID		##[[Homatropine]] 5% BID-TID

ClaireLewis at 04:09, 26 May 2019

2019-05-26T04:09:51Z

← Older revision		Revision as of 04:09, 26 May 2019
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	==Management==		==Management==
	#PO analgesia		#PO analgesia
	#~~Cycloplegics~~ paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.</ref>		#[[Cycloplegic]]s paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.</ref>
	##[[Homatropine]] 5% BID-TID		##[[Homatropine]] 5% BID-TID
	##[[Cyclopentolate]] 2% TID		##[[Cyclopentolate]] 2% TID

Ostermayer: /* Clinical Features */

2019-05-23T20:50:22Z

Clinical Features

← Older revision		Revision as of 20:50, 23 May 2019
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	*Photophobia (direct and consensual)		*Photophobia (direct and consensual)
	*Sluggish pupil		*Sluggish pupil
	*Hypopyon (severe cases): leukocytic exudate in anterior chamber		*[[Hypopyon]] (severe cases): leukocytic exudate in anterior chamber
	*Cell & flare (anterior chamber reaction)		*Cell & flare (anterior chamber reaction)
	**“Cell:” individual cells floating in the anterior chamber (look like dust specks)		**“Cell:” individual cells floating in the anterior chamber (look like dust specks)

ClaireLewis: /* Management */

2017-08-17T06:26:28Z

Management

← Older revision		Revision as of 06:26, 17 August 2017
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	#PO analgesia		#PO analgesia
	#Cycloplegics paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.</ref>		#Cycloplegics paralyze the ciliary body resulting in a nonreactive and dilated pupil, preventing synechiae, progression of flare, ciliary spasm pain<ref>Alexander KL, Dul MW, Lalle PA, Magnus DE. Onofrey B. Optometric Clinical Practice Guideline: Care of the Patient with Anterior Uveitis. St. Louis, MO: American Optometric Association; 1994:3-29.</ref>
	##Homatropine 5% BID-TID		##[[Homatropine]] 5% BID-TID
	##[[Cyclopentolate]] 2% TID		##[[Cyclopentolate]] 2% TID
	##[[Scopolamine]] 0.25% BID		##[[Scopolamine]] 0.25% BID

Josgood: /* Management */

2017-05-03T13:46:16Z

Management

← Older revision		Revision as of 13:46, 3 May 2017
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	##[[Cyclopentolate]] 2% TID		##[[Cyclopentolate]] 2% TID
	##[[Scopolamine]] 0.25% BID		##[[Scopolamine]] 0.25% BID
	#Topical steroids]] in consult with optho		#[[Corticosteroids#Ophthalmic Steroids\|Topical steroids]] in consult with optho
	##Rule out infection first and avoid corneal epithelial defect		##Rule out infection first and avoid corneal epithelial defect
	##[[Prednisolone]] acetate 0.5-1% QID		##[[Prednisolone]] acetate 0.5-1% QID