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Inflammation of the iris (iritis)


What is iritis?

The iris gives the eye its characteristic colour, depending on the amount of its pigmented cells.1 Together with the choroid (choroidea) and the ciliary body (corpus ciliare), it forms the vascular membrane (uvea).1There is an opening at the centre of the iris, the pupil.2 By changing the size of the pupil, the iris regulates the amount of light reaching the eye.1 Inflammation of the iris (iritis) can cause redness, pain and sensitivity to light.1-4 Often both eyes are affected.1

Inflammation in the front part of the uvea (anterior uveitis) can be divided into three types:1,4

  • Iritis: Inflammation of the iris
  • Cyclitis: Inflammation of the ciliary body
  • Iridocyclitis: Inflammation of both structures

In Germany, approximately 400,000 people are affected by inflammation of the uvea.4,5 Combined inflammation of the iris and the ciliary body, known as iridocyclitis, often occurs because the two structures are anatomically close to each other.3

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What causes iritis?

Iritis can have several causes. In rarer cases, it may be infectious, e.g. caused by bacteria, viruses or parasites, or occur due to underlying systemic diseases.3 However, the more common cause is an immune response as part of underlying inflammatory diseases.3 The most common underlying diseases include:1,3,4

  • Immunological diseases: Behcet’s disease
  • Chronic inflammatory bowel diseases: Ulcerative colitis, Crohn’s disease
  • Rheumatic diseases: HLA-B27-associated diseases (Bechterew’s disease, Reiter’s syndrome), juvenile rheumatoid arthritis, sarcoidosis
  • Infectious diseases: Herpes infections, syphilis, tuberculosis, Lyme disease (borreliosis), leptospirosis

How does iritis manifest itself?

Iritis can be acute, recurrent or chronic.3,4 Typical symptoms include redness, pain, sensitivity to light, pupil constriction, increased lacrimation (epiphora) and visual impairment.3,6

In chronic and recurrent forms, intraocular pressure may increase, the iris may stick to the underlying lens (synechiae), inflammatory cells may be deposited in the anterior chamber (hypopyon) or premature lens opacity (cataract) may occur.3

How is iritis diagnosed?

An ophthalmological examination should be carried out if there are symptoms that could indicate iritis. With the aid of a slit lamp, which allows magnification of the eye, an eye specialist can assess the type and location of the inflammation, as well as the size or movement of the pupil.3,7 Since an associated impairment of visual function is possible, a test of visual acuity should also be carried out.2,3

How is iritis treated?

If the iritis is the result of an underlying disease, the disease must be treated to control the inflammation and prevent recurrence.2

The symptoms in the eye are additionally treated locally with pain-relieving and anti-inflammatory eye drops or ointments, with or without cortisone.2,3 The pupil can be dilated using special eye drops.3 If the patient is very sensitive to light, protective goggles can be prescribed.3 In the case of infectious iritis, antibiotic or antiviral therapy is indicated.4 Therapy lasting several weeks is usually necessary to prevent recurrence.4

In rare, very severe cases, anti-inflammatory medication in the form of tablets may also be indicated.2,3 To avoid complications, close follow-up by an eye specialist is very important.4

References

    1. Grehn F. Augenheilkunde. Springer Berlin Heidelberg 2019.

      2. Walter P, Plange N. Basiswissen Augenheilkunde. Springer Berlin Heidelberg 2016.

        3. Goebeler M, Walter P, Westhofen M. Augenheilkunde, Dermatologie, HNO in 5 Tagen. Springer Berlin Heidelberg 2018.

          4. Berufsverband der Augenärzte Deutschlands e.V., Deutsche Ophthalmologische Gesellschaft e.V. Leitlinie Nr. 14a Uveitis anterior 2010.

            5. Fiehn C, Zierhut M, Becker M. Differenzialdiagnose der Uveitis. Dtsch Arztebl International 2003; 100: A-2514-.

              6. Lang GK, Lang GE (Hrsg. 2015). Augenheilkunde essentials. Georg Thieme Verlag, Stuttgart, New York, 2015.

                7. Kampik A, Grehn F (Hrsg. 2008). Augenärztliche Differenzialdiagnose. 1. Auflage Thieme, s.l., 2008.