Download Acute iritis

Acute iritis
Recommend
 Consult MO immediately
 Urgent ophthalmologist referral within 24 hours [1]
Background
 Several groups of patients are at risk including those who have had past attacks of iritis, those with a
seronegative arthropathy and those who have had infections such as herpes zoster (shingles) of the
ophthalmic nerve, syphilis and tuberculosis
1.
May present with:
 Pain, photophobia, unilateral red eye
 The inflammation is more pronounced on the sclera adjacent to the cornea
 The pupil is small and may be irregular
 Inflammatory (pus) cells may settle at the bottom of the anterior chamber forming
a collection called a hypopyon
2.
Immediate management:
 Consult MO
3.
Clinical assessment:
 Obtain a comprehensive patient history with particular note:
 medical history – history of infections? STI’s? inflammation? [1]
 family history, current medications
 Perform standard clinical observations
 Examine both eyes
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4.
start with visual acuities – visual acuity may be normal at first, but later it is impaired
there is no staining with fluorescein. does the patient have photophobia?
is the anterior chamber of the eye cloudy? Is there a collection of white at the bottom of the
anterior chamber?
Management:
 Consult MO (if not already done) and discuss management including whether
 can be treated with topical steroids
 evacuation/hospitalisation is needed for Ophthalmologist review within 24 hours
 Analgesia: Paracetamol/Codeine
See Simple Analgesia Protocol (back cover)
5.
Follow up:
 If not evacuated/hospitalised review daily and consult MO on each review
 See next MO visit
6.
Referral/Consultation:

Consult MO on all occasions if acute iritis suspected