In every individual, the uvea is the middle part of the eye which consists of the iris, ciliary body, and choroid. Uvea helps supply blood to the iris and the retina. When an inflammation occurs in the uvea, it is known as uveitis. Inflammation in the anterior part, i.e., the front part of the eye (iris and ciliary body), is called iritis. If the inflammation occurs in the posterior part, i.e., the back part of the eye (choroid), it is known as choroiditis. The inflammation can further spread to surrounding tissues like the retina, optic nerve, and sclera.
Uveitis can cause vision changes or blindness in 5-10% of patients. The prevalence of uveitis depends on age, gender, genes, geography, and lifestyle. Anterior chamber iritis is the most common form of uveitis, with healthy young and middle-aged individuals more susceptible to it. Idiopathic uveitis (where the cause of uveitis is unknown) is the most common type of uveitis. Iritis that occurs due to any underlying infections is more common in developing countries. In developed countries, iritis that occurs due to causes other than infection is more common.
Types
Iritis is a form of uveitis. Depending on the part of the uvea affected, uveitis can be of three types:
Anterior uveitis or iritis: In this form of uveitis, the inflammation occurs in the iris and ciliary body of the eye. In some mild cases, the symptoms of iritis can resolve on their own.
Posterior uveitis or choroiditis: In this form of uveitis, the inflammation occurs in the choroid. Choroiditis is a severe form of uveitis that can affect the retina, optic nerve, and choroid. Choroiditis can recur in individuals, and the symptoms may last for months or even years.
Intermediate uveitis or pars planitis: In this form of uveitis, the inflammation occurs in a region between the iris and choroid. Young adults are more prone to get pars planitis. Symptoms last for a short duration but can recur.
Pan uveitis: In this condition, uveitis occurs in all three layers of the eye. Pan uveitis is a rare condition; however, it is severe and can cause permanent vision loss.
Uveitis can also be categorized into three types based on the time the condition lasts in a patient.
Acute uveitis: This condition improves within three months after the initiation of treatment.
Chronic uveitis: The symptoms recur after stopping the treatment.
Recurrent uveitis: Uveitis repeatedly occurs at intervals.
Symptoms
An individual can get iritis in one or both eyes, which causes the following symptoms:
Eye pain
Blurred vision
Eye redness
A slowly decreasing vision associated with eye pain
Watery eyes
Increased sensitivity to the light
Dark spots in the vision (eye floaters)
Some symptoms of iritis are similar to other eye conditions. Hence, having these symptoms does not necessarily mean that a person has iritis. An individual should consult an ophthalmologist to get a correct diagnosis.
Causes And Risk Factors
Causes
In many individuals, the cause of iritis is unknown. In some patients, blunt force trauma can cause iritis. Iritis also occurs due to eye surgery, eye injury, autoimmune disorders, or microbial infections.
An autoimmune disorder occurs when an individual's immune system attacks the body’s healthy tissues. Such conditions, which can cause uveitis, include:
Ankylosing spondylitis
Juvenile rheumatoid arthritis
Reactive arthritis
Reiter syndrome
Sarcoidosis
Behcet's disease
Psoriasis
Ulcerative colitis
Microbial infections that can cause iritis are:
Syphilis
Herpes simplex
Varicella-zoster
AIDS
Cytomegalovirus retinitis
Tuberculosis
Histoplasmosis
Toxoplasmosis
Kawasaki disease
Risk Factors
Genetic changes can increase a person’s risk of developing iritis. Females and aged persons are at a higher risk of contracting uveitis. An individual who smokes also has a higher chance of developing iritis.
Prevention
As the cause of iritis is unknown in most cases, the prevention strategies are limited. An individual should maintain good eye health and avoid smoking. An individual can also decrease the risk of having iritis by getting treated if they have any health conditions that are linked to causing iritis.
Diagnosis
Depending on the suspected cause of iritis, the diagnostic methods can differ. Upon initial visit, the doctor will perform an eye exam to check for vision loss, and intraocular pressure and check the inside of the patient’s eyes using special lenses. The list of eye examinations carried out by the doctor are:
Visual acuity test
Ocular pressure test
Slit-lamp exam
Dilated eye exam
The doctors will perform laboratory tests to check for a person’s immunity and any infection. If tuberculosis or sarcoidosis is responsible for causing uveitis, the doctors will perform chest radiography. Laboratory tests include:
Other tests carried out by the doctor for iritis include:
Gonioscopy: This diagnostic method is used to check the front part of the eye from where tearing occurs.
Optical coherence tomography: This method is helpful to obtain images of the retina. Another technique called optical coherence tomography angiography is used to obtain 3-dimensional images of the arteries and veins in the posterior part of the eye.
Fluorescein angiography: This method helps obtain images of the blood vessels in the rear part of the eye.
Visual field test: This diagnostic method is helpful in examining the optic nerve that is causing peripheral vision (seeing objects off to the side) in an individual.
Brain imaging: This diagnostic method helps identify the underlying causes of inflammation.
Treatment
The treatment for iritis mainly focuses on reducing eye inflammation and pain, restoring vision, and preventing any associated with iritis. Usually, most the iritis cases are mild and can be easily treated with eye drops and dark glasses. An individual is advised to wear dark glasses if they have an increased sensitivity to light. Your healthcare provider may choose from the following treatments for iritis:
Eyedrops
Steroids
Antibiotics, antivirals, antifungals
Immunosuppressants
The doctors prescribe eye drops that help relieve pain by dilating the pupil. Patients will also be prescribed eye drops to reduce intraocular pressure and prevent the lens and iris from sticking to each other. If iritis occurred due to any microbial infection, the doctors would also prescribe medications (antibiotics, antivirals, or antifungals) to treat the infection. If iritis does not improve,
the doctors will prescribe oral steroids, steroid eye drops, or steroid eye injections. In severe cases of iritis, where the patients do not respond to steroid medications, chemotherapeutic agents or immunosuppressants that act on the body’s immune system are prescribed.
An individual should consult an ophthalmologist immediately if they notice pain, redness, or inflammation in the eye. If iritis is left untreated, it can lead to vision loss. Mild cases of iritis can go away quickly with the help of treatment. In some individuals, iritis can take a long time to get treated, or the symptoms can recur.
Rarely, an individual with a repeated or severe form of iritis, or infections as a causative agent for iritis, may require surgery. Vitrectomy – a surgical procedure – is also available for treating iritis.
Prognosis And Complications
Prognosis
As discussed earlier, anterior uveitis or iritis is usually mild and can be easily treated by medications. Proper treatment and a regular follow-up will help get rid of iritis in a few days or weeks. However, iritis can recur in individuals.
Complications
If iritis is left untreated or not treated properly, complications can arise. Also, complications increase in individuals above 60 years of age and with chronic iritis. Complications of iritis include:
Raised intraocular pressure
Deterioration of optic nerve
Vision loss
Cataracts (this complication can also arise due to vitrectomy)
Irregular pupil size
Glaucoma
Cystoid macular oedema
Cushing’s syndrome
Fluid build-up in the retina
Detachment of retina from the surrounding tissue
Stomach ulcers
Fluid retention and swelling in the body
Weight gain
Diabetes
Heart problems
Osteoporosis
In iritis, the intraocular pressure rises due to inflammation, the use of corticosteroids, or a pupillary block. Raised intraocular pressure can further cause deterioration of the optic nerves and cause a sudden vision loss. An incorrect treatment using steroids can also complicate iritis. Early detection and proper treatment will reduce the risk of permanent vision loss or other complications of iritis.
Alternative Treatments
Alternative therapies for iritis include:
Ayurvedic management
In Ayurveda, individual suffering from anterior uveitis is treated with the following:
Blood purification therapy
Therapeutic purgation
Herbal eye drops
Herbal ocular ointment)
Retention of ghee over eyes
Herbal paste
Ocular irrigation
Inhalation of medicinal smoke
Retention of specially prepared medicine over eyes[12]
An individual should consult a doctor or an ophthalmologist before initiating any alternative treatment.
References.
Iritis. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430909/
Uveitis. MedlinePlus. Available at: https://medlineplus.gov/ency/article/001005.htm.
Uveitis (iritis). University of Michigan Health. Available at: https://www.umkelloggeye.org/conditions-treatments/uveitis-iritis.
Tsirouki T, et al. A focus on the epidemiology of uveitis. Ocul Immunol Inflamm. 2018;26(1):2-16.
Uveitis. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/14414-uveitis.
Uveitis – Overview. NHS. Available at: https://www.nhs.uk/conditions/uveitis/.
Uveitis. American Academy of Ophthalmology. Available at: https://www.aao.org/eye-health/diseases/uveitis-causes.
Uveitis. Library of U.S. Courts. Available at: http://www.lb7.uscourts.gov/documents/18c1375.pdf.
Zhang Y, et al. Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis. Plos One. 2020, Aug 25:1-16.
Anterior uveitis. Columbia University. Available at: https://www.columbiaeye.org/education/digital-reference-of-ophthalmology/cornea-external-diseases/non-infectious/anterior-uveitis.
Uveitis – Treatment. NHS. Available at: https://www.nhs.uk/conditions/uveitis/treatment/.
Bhat AK, et al. Ayurvedic management of recurrent anterior uveitis (Raktaja adhimantha) with bloodletting therapy: A case report. Journal of Ayurveda Case Reports. 2021 Aug 16;4(2):54-57.
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