Thursday, 9 September 2010

MRCP revision battle 6.2: acute iritis

If you're anything like me eyes are a bit a vague part of the body... as an A&E SHO I hated dealing with 'the red eye'.  The good news is that MRCP doesn't have too many ophthalmology questions so there aren't too many topics you have to be familiar with.  One not to miss however is acute iritis.

As an aside, acute irits and anterior uveitis are often used by doctors almost interchangeably, but technically anterior uveitis encompasses both iritis (inflammation of the iris) and iridocyclitis (inflammation of the iris and ciliary body).  Fortunately management is pretty much the same.

Acute iritis presents as:
  • red eye ('circumcorneal redness'
  • pain
  • photophobia
  • blurred vision
  • lacrimation
  • small pupil (in reccurent cases the pupil may be irregular due to adhesions)

You may be able to illicit a positive Talbot's test, which is an increase in the patient's pain when you get their eyes to converge (due to the pupils constricting)

On slit lamp examination you may spot:
  • cells in the anterior chamber
  • white precipitates on back of cornea
  • sometimes a hypopyon (= sterile anterior chamber pus)

It is associated with ankylosing spondylitis and also Bechets disease.
It may relapse.

Treatment requires ophthalmic input due to the need for steroids - and if steroids are given inappropriately to an infected eye the patient may become blind....

On that happy note, lets move on to Reiters Syndrome