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definition of irisitis
 
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Published: 19 years ago
 
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definition of irisitis


---Drawn out definition alert---
Iritis/ uveitis
Background: Iritis, or anterior uveitis, is the most common form of ocular inflammation encountered. It is a common cause of a painful red eye. Inflammation of the iris may appropriately be termed iritis, while inflammation of the iris and the ciliary body is called iridocyclitis. Iritis may be subdivided into 2 broad categories: granulomatous and nongranulomatous.

This article addresses nongranulomatous iritis, although iritis from a granulomatous disease process may present with a nongranulomatous appearance.


Pathophysiology: The exact pathophysiology is not known. Inflammation of the iris and the ciliary body causes a breakdown of the blood ocular barrier. This condition allows both protein and WBCs to extravasate into the aqueous, resulting in the typical iritis signs of cell and flare. Frequently, the cause is idiopathic, but certain ocular and systemic diseases may be the underlying cause of the iritis.


Frequency:


In the US: Iritis is the most frequent form of uveitis encountered by ophthalmologists. In one community-based study, anterior uveitis accounted for more than 90% of all patients with uveitis. The annual incidence rate is approximately 8 cases per 100,000 population.
Internationally: No particular geographic distribution has been noted for iritis.
Mortality/Morbidity:

Morbidity arises from iritis and from an associated disease process if present.
Patients may develop posterior synechiae, and, if severe, a secluded pupil and subsequent angle-closure glaucoma may result.
Associated ocular complications (eg, cataract, glaucoma) may result in severe vision loss.
Race: No significant racial differences exist.

Sex: No significant sexual differences exist.

Age: Individuals may develop iritis at any age. Mean age is approximately 45 years.

Causes:

Idiopathic
HLA-B27–associated diseases
Ankylosing spondylitis
Reiter syndrome
Inflammatory bowel disease
Psoriasis
Sarcoidosis
Trauma
Infections
Herpes zoster/herpes simplex
Syphilis
Lyme disease
Juvenile Rheumatoid Arthritis
Lens-associated uveitis
Fuchs heterochromic iridocyclitis

Procedures:


If a patient presents with a secluded pupil from extensive posterior synechiae, iris bombe with angle-closure glaucoma may be present. In this case, an iridotomy should be performed as soon as possible.

Medical Care:

Cycloplegia: A long-acting cycloplegic agent, such as cyclopentolate or homatropine, should be used to help relieve both pain and photophobia, as well as to prevent the formation of posterior synechiae.
Corticosteroids
Topical corticosteroids are the mainstay of therapy and should be used aggressively during the initial phases of therapy.
A subconjunctival injection of depot-steroids (eg, Celestone) may be used if the patient demonstrates poor compliance with topical therapy or if the iritis is not responding to topical corticosteroids alone.
In severe cases of iritis, the addition of oral corticosteroids to the treatment regimen may be necessary.
If IOP is elevated, a topical aqueous suppressant should be used.
Consultations: If warranted from information obtained during the patient's history, consultations to other subspecialists should be arranged

Further Outpatient Care:


Patients require close follow-up care, with steroids tapered as the inflammation resolves. Patients should be reexamined 2-3 weeks after all medications have been tapered to ensure that no residual inflammation exists.
Complications:


Recurrent episodes of iritis and subsequent therapy may lead to cataract formation and glaucoma development.
Prognosis:


Most patients can expect to have a recurrence of iritis. Overall, the visual prognosis for patients with recurrent iritis is good in the absence of either cataract formation or glaucoma development.
Patient Education:


If the patient is known to have or has been recently diagnosed with HLA-B27, the patient should be instructed to always keep a bottle of steroids. The patient should instill the steroid at the first sign of an iritis flare. The patient should come into the office as soon as possible to confirm the presence or the absence of the iritis.

Medical/Legal Pitfalls:


Because uveitis may be part of a systemic syndrome, performing a full review of systems is critical. By failing to do so, a systemic process may be missed. This failure to diagnose and refer to an appropriate subspecialist may result in undue morbidity.

http://www.emedicine.com/oph/topic587.htm




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---Drawn out definition alert---
Iritis/ uveitis
Background: Iritis, or anterior uveitis, is the most common form of ocular inflammation encountered. It is a common cause of a painful red eye. Inflammation of the iris may appropriately be termed iritis, while inflammation of the iris and the ciliary body is called iridocyclitis. Iritis may be subdivided into 2 broad categories: granulomatous and nongranulomatous.

This article addresses nongranulomatous iritis, although iritis from a granulomatous disease process may present with a nongranulomatous appearance.


Pathophysiology: The exact pathophysiology is not known. Inflammation of the iris and the ciliary body causes a breakdown of the blood ocular barrier. This condition allows both protein and WBCs to extravasate into the aqueous, resulting in the typical iritis signs of cell and flare. Frequently, the cause is idiopathic, but certain ocular and systemic diseases may be the underlying cause of the iritis.


Frequency:


In the US: Iritis is the most frequent form of uveitis encountered by ophthalmologists. In one community-based study, anterior uveitis accounted for more than 90% of all patients with uveitis. The annual incidence rate is approximately 8 cases per 100,000 population.
Internationally: No particular geographic distribution has been noted for iritis.
Mortality/Morbidity:

Morbidity arises from iritis and from an associated disease process if present.
Patients may develop posterior synechiae, and, if severe, a secluded pupil and subsequent angle-closure glaucoma may result.
Associated ocular complications (eg, cataract, glaucoma) may result in severe vision loss.
Race: No significant racial differences exist.

Sex: No significant sexual differences exist.

Age: Individuals may develop iritis at any age. Mean age is approximately 45 years.

Causes:

Idiopathic
HLA-B27–associated diseases
Ankylosing spondylitis
Reiter syndrome
Inflammatory bowel disease
Psoriasis
Sarcoidosis
Trauma
Infections
Herpes zoster/herpes simplex
Syphilis
Lyme disease
Juvenile Rheumatoid Arthritis
Lens-associated uveitis
Fuchs heterochromic iridocyclitis

Procedures:


If a patient presents with a secluded pupil from extensive posterior synechiae, iris bombe with angle-closure glaucoma may be present. In this case, an iridotomy should be performed as soon as possible.

Medical Care:

Cycloplegia: A long-acting cycloplegic agent, such as cyclopentolate or homatropine, should be used to help relieve both pain and photophobia, as well as to prevent the formation of posterior synechiae.
Corticosteroids
Topical corticosteroids are the mainstay of therapy and should be used aggressively during the initial phases of therapy.
A subconjunctival injection of depot-steroids (eg, Celestone) may be used if the patient demonstrates poor compliance with topical therapy or if the iritis is not responding to topical corticosteroids alone.
In severe cases of iritis, the addition of oral corticosteroids to the treatment regimen may be necessary.
If IOP is elevated, a topical aqueous suppressant should be used.
Consultations: If warranted from information obtained during the patient's history, consultations to other subspecialists should be arranged

Further Outpatient Care:


Patients require close follow-up care, with steroids tapered as the inflammation resolves. Patients should be reexamined 2-3 weeks after all medications have been tapered to ensure that no residual inflammation exists.
Complications:


Recurrent episodes of iritis and subsequent therapy may lead to cataract formation and glaucoma development.
Prognosis:


Most patients can expect to have a recurrence of iritis. Overall, the visual prognosis for patients with recurrent iritis is good in the absence of either cataract formation or glaucoma development.
Patient Education:


If the patient is known to have or has been recently diagnosed with HLA-B27, the patient should be instructed to always keep a bottle of steroids. The patient should instill the steroid at the first sign of an iritis flare. The patient should come into the office as soon as possible to confirm the presence or the absence of the iritis.

Medical/Legal Pitfalls:


Because uveitis may be part of a systemic syndrome, performing a full review of systems is critical. By failing to do so, a systemic process may be missed. This failure to diagnose and refer to an appropriate subspecialist may result in undue morbidity.

http://www.emedicine.com/oph/topic587.htm



emedicine's explanation which of course includes a full load of 'necessary' medication

 

 
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