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Iris

Iritis is a type of uveitis — inflammation of the middle layer of the eye (uvea) — that affects your eye's iris. The iris is the colored ring of tissue surrounding your pupil, which lies just behind the transparent cornea. Muscles controlling the iris change the size of the pupil to adjust to light conditions. Prolonged inflammation can lead to adhesions of the iris, causing your pupil to become smaller or irregularly shaped and predisposing you to glaucoma.

Often, iritis can't be linked to a specific cause. But sometimes, iritis results from an underlying chronic condition or genetic factor.

Also referred to as anterior uveitis, iritis is a serious condition that, if left untreated, could lead to blindness. If you have symptoms of iritis, see your doctor as soon as possible for evaluation and treatment.

Signs and symptoms of iritis may include:

• Eye redness, often seen as a blush pink color in the white of your eye (sclera) around the iris
• Discomfort or achiness in the affected eye
• Sensitivity to light (photophobia)
• Blurred vision
• Floating spots in the vision (eye floaters)

Iritis usually isn't associated with eye discharge or increased tearing.

When symptoms of iritis develop suddenly, over a period of a few hours or days, this is referred to as acute iritis. Symptoms that develop gradually, or last longer than six weeks, indicate chronic iritis.

When to see a doctor
See a doctor as soon as possible if you have symptoms of iritis. Prompt treatment helps prevent any serious complications of the condition. Your doctor may refer you to an eye specialist (ophthalmologist). If you're experiencing eye pain and vision problems, along with other signs and symptoms, you may need urgent medical care.

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Iris and other parts of the eye

Often, the cause of iritis can't be determined. Iritis can be classified as acute when symptoms develop rapidly, or as chronic when symptoms develop gradually and tend to last over a period of weeks to months.

Known causes of iritis include:

• Injury to the eye. Blunt force trauma, a penetrating injury or burn (chemical or thermal) to your eye can cause acute iritis.
• Herpes infection. Infection with herpes zoster — commonly known as shingles — can cause iritis if you have a skin eruption on your face, especially your forehead or cheeks. Other infectious diseases, such as toxoplasmosis, histoplasmosis, tuberculosis and syphilis, may be linked to other types of uveitis.
• Genetic predisposition. People with HLA-B27, a specific alteration of a gene that's essential to immune system function, are more likely to develop certain autoimmune diseases, such as ankylosing spondylitis, Reiter's syndrome, inflammatory bowel disease and psoriatic arthritis. Acute iritis may occur in these diseases.
• Bechet's disease. An uncommon cause of acute iritis in Western countries, this condition is also characterized by joint problems, mouth sores and genital lesions.
• Juvenile rheumatoid arthritis. Chronic iritis can develop in children with juvenile rheumatoid arthritis. In cases where the condition is mild and affects only a few joints, iritis may be one of the first indications of the condition. Juvenile rheumatoid arthritis more commonly affects girls. Because the two conditions are so commonly associated with each other, doctors often routinely screen for iritis or other types of uveitis in kids with rheumatoid arthritis.
• Posterior uveitis. Inflammation starting in the back part of your eye (posterior uveitis) can have a spillover effect on the parts of the uvea at the front of your eye.

Your risk of developing iritis increases if you:

• Carry the HLA-B27 genotype.
• Develop a sexually transmitted disease (STD), because infections such as syphilis or human immunodeficiency virus (HIV) are linked with a significantly increased risk.
• Live in certain geographic locations where infectious causes are more prevalent, for instance, in the Ohio or Mississippi river valleys where histoplasmosis occurs more frequently.
• Have a compromised immune system or autoimmune disorder.

If not treated properly, iritis could lead to complications, including:

• Cataracts. Development of a clouding of the lens of your eye (cataract) is a common complication, especially if you've experienced a long period of inflammation.
• Glaucoma. Recurrent iritis could result in glaucoma, a serious eye condition characterized by increased eye (ocular) pressure and threatened vision loss.
• Calcium deposits on the cornea (band keratopathy). This condition results in degeneration of your cornea and could decrease your vision.
• Swelling within the retina (cystoid macular edema). Swelling and fluid-filled cysts that develop in the retina at the back of the eye (macular retina) can blur or decrease your central vision.

Set an appointment with a doctor who specializes in eye care — an optometrist or an ophthalmologist — who can evaluate your condition and perform a complete eye exam.

What you can do
Make the best use of limited time with your doctor by preparing beforehand.

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance.
• Write down your symptoms, including any that may seem unrelated to your vision problem.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Ask a family member or friend to accompany you, if possible. Having your pupils dilated for the eye exam will affect your vision for a time afterward. You may need someone else to drive or accompany you after your appointment.

Questions to ask your eye doctor

• Can iritis permanently affect my vision?
• Do I need to come back for any follow up exams? When?
• What should I do if my symptoms don't go away or seem to worsen?

Questions your eye doctor may ask

• When did you first notice symptoms?
• Are symptoms present in one or both eyes?
• Do you feel pain in your eye after touching your eyelid?
• Do you have headaches?
• Does bright light worsen your eye pain?
• Do you have blurred vision?
• Do you have trouble seeing things near you, at a distance or both?
• Have you recently experienced an injury or other trauma to your eye?
• Have you recently had a viral-like illness?
• Do you have symptoms of arthritis, such as joint pain?
• Do you have any sores in your mouth or on your genitals?
• Have you been diagnosed or treated for iritis before?
• Have you been diagnosed or treated for any other eye condition?

Before diagnosing iritis, your eye doctor will conduct a complete eye exam, including:

• External examination. During an external exam, your doctor may use a penlight to look at your pupils, observe the pattern of redness in your eye or eyes, and check for signs of discharge.
• Visual acuity. Your doctor will note your visual acuity using an eye chart and other standard tests.
• Slit-lamp examination. Using a special microscope with a light on it, your eye doctor views the inside of your eye looking for telltale signs of iritis, including the presence of white blood cells or hazy protein deposits (termed "flare"). To better view your eye's interior, your doctor may give you eyedrops to dilate your pupil.
• Glaucoma testing. During a glaucoma test, your eye doctor measures your intraocular pressure. Elevated intraocular pressure indicates that you may have glaucoma.

If your eye doctor suspects that a systemic condition is causing your iritis, he or she may work closely with your primary care provider to pinpoint the underlying cause. In that case, further testing may include blood tests or X-rays to identify or rule out specific causes.

The main goals in treating iritis are to preserve vision and relieve any pain associated with the condition.

Most often, treatment for iritis involves:

• Steroid eyedrops. Glucocorticoid medications, given as eyedrops, reduce inflammation associated with iritis. They work by stabilizing cell membranes in your eye and minimizing the circulation of white blood cells and other byproducts of the inflammatory process.
• Dilating eyedrops. Cycloplegics are medicines that dilate your pupil. Given as eyedrops, they can reduce pain associated with iritis. Dilating eyedrops also protect you from developing adhesions underneath your iris, which can lead to potential complications, including glaucoma.

If your symptoms don't clear up, or seem to get worse, your eye doctor might prescribe oral medications that may include steroids or other anti-inflammatory agents. However, taking the medicine orally has the potential to affect not only your eyes, but other parts of your body as well. Your doctor will consider your overall condition before prescribing oral medications to treat your iritis.