What Is Traumatic Iritis?

Inflammation of the Iris Caused by an Eye Injury

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Traumatic iritis is inflammation of the iris—the colored portion of the eye—due to trauma. It is most often caused by a blunt force injury but can be caused by other types of injury.

Also known as anterior uveitis, the symptoms of traumatic iritis typically include eye pain, severe redness, and blurry vision in the affected eye. If not diagnosed or treated in a timely manner, traumatic iritis can lead to permanent injury of the eye lens, reduced vision, and the development of glaucoma.

Young woman checking her eye in the mirror
Jose Luis Pelaez / Getty Images

Symptoms

Although there may be blurring of vision and pain at the time an injury occurs, the symptoms of traumatic iritis usually do not develop until two to three days later.

Common

Common symptoms of traumatic iritis include:

  • Eye pain that cannot be relieved with anesthetic eye drops
  • Blurred or decreased vision
  • Tearing of the eye
  • Floaters (tiny specks or "cobwebs" floating in the field of vision)
  • Photophobia (extreme sensitivity to light)
  • Ciliary flush (a ring of extreme redness around the iris)
  • Hypopyon (accumulation of pus, often seen as a white blotch on the bottom edge of the iris)
  • Vossius ring (a ring of opacity on the back of the lens caused by the release of pigments from traumatized tissues)

Severe

Traumatic iritis is characterized by inflammation, the body's natural response to injury or infection. If left unchecked, extreme inflammation can cause parts of the iris and lens to stick together—a condition known as synechia.

This, in turn, can affect the movement of fluid through the eye, causing the iris to bulge. The increased pressure can lead to a serious complication known as angle-closure glaucoma.

The rapid onset of angle-closure glaucoma usually requires emergency intervention to prevent permanent vision loss.

Causes

Traumatic iritis most often results from a blunt force injury to the eye that ruptures, trears, or bruises the iris. It can also be caused by a penetrating injury, a chemical or fire burn, the jarring of the head during an automobile accident, or an explosion (such as fireworks) near the eye.

With traumatic iritis, the eye injury will trigger an inflammatory response, wherein white blood cells and proteins will rapidly accumulate between the iris and lens. This is referred to as "cell and flare" as the build-up of white blood cells gives the eye a dusty appearance, while the accumulation of proteins creates smoke-like trails. This also creates the floaters that people with traumatic iritis typically see.

The acute inflammatory response will also cause the fluid in the front of the eye, called the aqueous humor, to thicken, causing blurring. It can also render the pupil less responsive to light, leading to photophobia. The release of blood and pigments from ruptured tissues can cause other characteristic abnormalities, such as ciliary flush and a Vossius ring.

Inflammation associated with traumatic iritis can often increase intraocular pressure (pressure within the eye). This can further amplify inflammation within the eye, increasing the risk of hypopyon, synechiae, and angle-closure glaucoma.

Diagnosis

Traumatic iritis is typically diagnosed by visual inspection of the eye along with a review of symptoms and medical history. It is usually diagnosed by an eye specialist known as an ophthalmologist.

Some of the visual signs of traumatic iritis, like ciliary flush, Vossius ring, and hypopyon, can be seen with the naked eye. Others, like cell and flare or synechiae, require a special high-powered microscope called a slit lamp to view inside the eye. In addition, the doctor will use a penlight to test your pupil reflex and perform a visual acuity test to determine the extent of vision impairment.

Intraocular pressure can be measured with ocular tonometry, also known as the "air puff test."

Lab tests are not used to diagnose traumatic iritis. The diagnosis is based purely on the physical signs and symptoms, along with the identification of the traumatic event.

With that said, the doctor may order additional tests if the cause is less than certain. The differential diagnosis, used to exclude other possible cause, may include disorders such as:

Treatment

The first-line treatment for traumatic iritis is administration of cycloplegic eye drops to dilate the pupil. This relieves pain caused by eye spasms and also prevents tissues from sticking together, reducing the risk of synechiae. Common options include cyclopentolate 2% used three times daily or scopolamine 0.25% used twice daily.

Corticosteroid eye drops may also be used to alleviate inflammation. They work by tempering the local immune response and release of inflammatory cytokines. Prednisolone acetate 1% is one of the most commonly used steroid eye drops. It is generally used four times daily for several days, after which the dose is gradually tapered to avoid a rebound in symptoms.

If the symptoms of iritis have improved after five to seven days, cycloplegic eye drops can be stopped and steroid eye drops can be gradually tapered to discontinue.

Temporary avoidance of anticoagulants (blood thinners) and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or Advil (ibuprofen) may be advisable if there is traumatic eye bleeding, as these drugs can promote bleeding and increase the risk of eye complications.

A follow-up exam should be scheduled one month later to assess whether there any signs of glaucoma.

A Word From Verywell

Traumatic iritis can be prevented by protecting your eyes. If you are engaging in any activity in which there are flying objects, heavy machinery, or caustic chemicals, protective goggles can prevent injury and spare your vision. Sports glasses should be considered whenever hunting, shooting, or participating in certain contact sports.

If you experience a blunt force injury to your eyes, do not wait for severe symptoms to develop before seeing a doctor.

When to Seek Medical Care

Call 911 or seek emergency care if any of the following occurs:

  • There are visual disturbances after even a light blow.
  • Your eye has been scratched, cut, or punctured.
  • You get chemicals in your eyes that cause burning pain.
  • You cannot flush a particle, like glass or metal, out of your eye.
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