What Is Traumatic Iritis?

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, reduced vision, and the development of glaucoma.

Symptoms

Although there may be blurring of vision and pain at the time an injury occurs, the symptoms of traumatic iritis will develop within hours to a day after an injury.

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
• Photophobia (extreme sensitivity to light)
• Ciliary flush (a ring of extreme redness around the iris)
  

Common signs may include:

• Hypopyon: A hypopyon is an accumulation of inflammatory and white blood cells, which appears as a white blotch on the bottom edge of the iris. It's more commonly seen in an infection rather than trauma.
• Vossius ring: This refers to a ring of opacity on the back of the lens caused by the release of pigments from traumatized tissues.
• Hyphema: Hyphema is when blood collects in the anterior chamber of the eye (the space between the cornea and the iris).
• Cells and flare: This refers to the presence of white blood cells and protein in the anterior chamber of the eye.
• Iris tear: The iris may have an irregular shape if it is damaged or torn.
• Angle recession: This refers to the traumatic separation between the longitudinal and circular muscle of the ciliary body.
• Unequal pupils: Unequal pupils can result from trauma and inflammation.
• Subconjunctival heme: This occurs when a blood vessel leaks just beneath the clear surface of the eye (conjunctiva). It appears as a red discoloration on the white of the eye.

Floaters—tiny specks or “cobwebs” floating in the field of vision—can also be a sign of trauma to the eye, though they may or may not be related to the iritis specifically.

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. When blunt trauma damages the eye's drainage system, it can lead to angle recession glaucoma.

Causes

Most commonly, a corneal abrasion causes traumatic iritis. It may also result from a blunt force injury to the eye that ruptures, tears, or bruises the iris, or 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.

In traumatic iritis, the eye injury will trigger an inflammatory response in which white blood cells and proteins will rapidly accumulate between the iris and lens. This is referred to as “cell and flare,” since the buildup of white blood cells gives the eye a dusty appearance, while the accumulation of proteins creates smoke-like trails.

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 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 eye specialists known as optometrists or ophthalmologists.

Some of the visual signs of traumatic iritis, such as 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, a healthcare provider 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.

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

• Corneal ulcer
• Detached retina
• Eye stroke
• Giant cell arteritis
• Herpes zoster ophthalmicus
• Optic neuritis
• Stroke
• Subconjunctival hemorrhage

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. Commonly, cyclopentolate 1% is used three times daily.

In addition, corticosteroid eye drops will be prescribed to alleviate inflammation. They work by tempering the local immune response and releasing inflammatory cytokines.

Prednisolone acetate 1% is one of the most commonly prescribed steroid eye drops. It is generally used four times daily for several days (more often in severe cases), after which the dose is gradually tapered to avoid a rebound in symptoms.

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. These drugs can promote bleeding and increase the risk of eye complications.

A Word From Verywell

Traumatic iritis can be prevented by protecting your eyes. If you are engaging in any activity that involves 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 healthcare provider or going to the emergency room.