The iris is the part of the eye that has color. It is a membrane filled with colored pigments. Inside its center is the pupil. The iris membrane is actually made from muscular fibers, controlling how much light can get into the pupil, enabling you to see clearly. It does this by contracting the pupil when it is exposed to bright light, and enlarging it in the dark. When the iris becomes inflamed, you have iritis, also often called uveitis.

Causes of Iritis

Iritis can be caused by a range of different factors. These include:

• Traumatic iritis, caused by blunt trauma that results in the iris becoming inflamed
• Non-traumatic iritis, caused by various diseases, such as psoriasis, inflammatory bowel disease, sarcoidosis, Reiter syndrome, and ankylosing spondylitis
• Infectious disease, including herpes zoster, herpes simplex, syphilis, toxoplasmosis, tuberculosis, and Lyme disease

Most of the time, however, the cause of iritis isn’t clear.

Symptoms of Iritis

Usually, iritis develops quickly, and it is generally found in one eye only. The following symptoms are common:

• Pain in the brow region of the eye.
• When exposed to bright light, the pain in the eye gets worse.
• Reddening of the eye, particularly next to the iris.
• Funny or small shaped pupil
• Headaches
• Blurred vision

The difference between uveitis and iritis is that iritis is an inflammation of the iris itself, whereas uveitis is an inflammation of the entire uvea, which is the middle part of the eye. Within the uvea, you find the choroid, the ciliary body, and the iris itself. When someone has iritis, they also have uveitis, specifically anterior uveitis.

It is common for these conditions to be chronic. Furthermore, they often lead to various complications, including cataracts, clouding of the cornea, swelling of the retina, elevated eye pressure, glaucoma, and retinal detachment. These are serious complications that can lead to full loss of vision.

Iritis is most common in people between the ages of 20 and 50. A study took place in California that estimated around 280,000 people in this country have some form of uveitis every year. This was quite shocking, as it was a number three times as high as previously believed. The study was completed by compiling the records of six communities in California. It also determines that the different forms of uveitis lead to 30,000 new people being registered blind every year. In fact, they estimated 10% of all cases of blindness are in fact caused by uveitis.

Iritis, or anterior uveitis, is actually the most common form of uveitis. There are between eight and 15 cases for every 100,000 of iritis each year. It is as common in men as it is in women.

If you are diagnosed with iritis, it is important that you ask the right questions so that you know what you are dealing with. Some of the things you must ask your physician include:

• Whether there is permanent damage to the eye
• Whether any permanent vision loss has already occurred
• What will happen during the healing process
• Whether you need to contact your physician if you notice any symptoms before your next appointment

Tests and Exams for Iritis

Iritis is diagnosed by looking at the eye with a special microscope made specifically for eye examinations, known as a slit lamp. This is generally done by an ophthalmologist, who will look at the white blood cells in your eyes, as well as the particles of protein, known as flare, that are created in the fluid of the eye itself, to determine whether iritis is present.

How Is Iritis Treated?

If your ophthalmologist determines that you do have iritis, you will generally be provided with a steroid prescription to bring the inflammation down. This steroid can be provided as an eyedrop, through an injection, or as an oral medication. The severity of your iritis will usually determine which type of treatment you need, although the eye drops tend to be the most commonly prescribed.

Steroids in Eye Drops Can Have Serious Side Effects

Unfortunately, steroids can lead to serious side effects. These include glaucoma, osteoporosis, high blood pressure, high blood sugar, kidney damage, and weight gain. You must be particularly aware of this if you have been prescribed oral steroids, because they are usually quite high in dosage so that enough of it can get to the back of the eye. This is why it is important that you follow the exact directions of your physician, and that you keep your appointments to determine whether the treatment is working or not.

As previously stated, iritis can be caused by underlying medical conditions. If this is the case with you, then that condition must be treated as well. Without it, the anterior uveitis will simply remain.

Prescription Medication Usually Required

Iritis almost always requires prescription medication as well as regular visits with an ophthalmologist. The medication should be used exactly as they were prescribed, and for the required duration. At the same time, however, there are certain things you can do to alleviate your symptoms as well. Most people with iritis find that wearing dark glasses is important, as it means their eyes are no longer hurt by bright light. Mild analgesics such as Advil (ibuprofen) or Tylenol (acetaminophen) can also be beneficial in lowering the levels of discomfort.

The drugs you will be prescribed for iritis are most likely to be eye drops at first. If they are ineffective, you will be prescribed pills. It is rare for iritis to be treated through injections. The drops are the most popular, because they can also help to widen the pupil, by preventing it from going into spasm. In so doing, the iris muscles can rest and heal, while at the same time decreasing the pain that people feel.

Steroid eyedrops are almost always prescribed, unless the iritis was caused by a viral or bacterial infectious agent. These drops are designed to lower the inflammation. However, if there is no notable improvement within one week, then different treatment will need to be considered, most notably pills. How long you have to use this treatment depends on how severe your iritis is, and how much improvement you experience.

Follow up Care

In every case of iritis, it is important that you get follow up care from an ophthalmologist. If the iritis is non-traumatic, then the ophthalmologist will determine whether there are any diseases present that have caused it to happen. To do this, they will likely refer you to specialized physicians for tests such as x-rays, scans, and blood tests.

Prognosis for Iritis

If you have  traumatic iritis, it will usually clear up in between one or two weeks. With non-traumatic iritis, it can take a lot longer, sometimes even months. With infectious iritis, the condition will resolve once the infection has resolved. However, in many cases, iritis becomes recurrent or chronic, particularly if people have ankylosing spondylitis or sarcoidosis, for instance.

In many cases, ophthalmologists will provide you with information on how to recognize the signs of iritis, particularly if you are at high risk of having it chronically. In that case, you are likely to have a permanent, rolling prescription for steroid eye drops, so that you can start treatment as soon as you notice the first signs of a recurrence. In so doing, you may be able to avoid any complications.

Resources and References:

• Modern Medicine Network – Future of Uveitis Therapy Takes Shape with New Treatments (OphthalmologyTimes.modernmedicine.com)
• American Optometric Association – Care of the Patient with Anterior Uveitis (AOA.org)
• Review of Optometry – The Basics of Uveitis (ReviewofOptometry.com)