Iritis (Inflammation of the Iris)

Iritis is an inflammation of the iris, the colored part of the eye that surrounds the pupil. It belongs to the group of anterior uveitis and can occur at any age, including in children. Rapid detection and treatment are important to avoid complications.

Symptoms

Acute iritis typically presents with:

• Eye pain (often dull, deep-seated)
• Redness of the eye (especially around the cornea)
• Light sensitivity (photophobia)
• Blurred vision
• Increased tearing
• A smaller pupil on the affected side
• Headaches

Caution in children: in children with juvenile idiopathic arthritis (JIA), iritis often runs its course without pain and without visible redness. In these cases the inflammation is only discovered during the regular slit-lamp examination by the ophthalmologist. For this reason, the recommended check-ups for JIA must be strictly observed.

Causes

Iritis can have various causes:

• Autoimmune diseases: juvenile idiopathic arthritis (JIA), ankylosing spondylitis, sarcoidosis, inflammatory bowel disease (Crohn's disease, ulcerative colitis)
• Infections: herpes viruses, toxoplasmosis, tuberculosis, and other pathogens
• Eye injuries: trauma can trigger inflammation of the iris
• Idiopathic: in many cases no clear cause can be identified

Possible complications

Without treatment, or with inadequate treatment, iritis can lead to serious consequences:

• Synechiae: adhesions between the iris and the lens that deform the pupil and obstruct the outflow of aqueous humor
• Cataract: both the inflammation itself and long-term steroid therapy can lead to clouding of the lens
• Glaucoma: raised intraocular pressure due to inflammation or as a side effect of therapy
• Macular edema: accumulation of fluid at the point of sharpest vision
• Band keratopathy: calcium deposits on the cornea, especially in chronic cases

Diagnosis

The ophthalmologist examines the eye with the slit lamp and looks for inflammatory cells in the anterior chamber of the eye. In addition, visual acuity, intraocular pressure, and the fundus of the eye are checked. Depending on the suspicion of an underlying disease, blood tests or imaging procedures may be ordered.

Treatment

Eye drops

• Steroid drops (cortisone): suppress the inflammation and are the first-line treatment. The dose is gradually reduced to avoid a relapse.
• Pupil-dilating drops (mydriatics/cycloplegics): keep the pupil wide and prevent the formation of synechiae. They also relieve the pain by relaxing the ciliary muscle.

Systemic therapy

In severe, recurrent cases or those associated with autoimmune diseases, the following may also be prescribed:

• Systemic steroids (tablets)
• Immunosuppressive medication (e.g. methotrexate)
• Biologics (e.g. adalimumab)

The choice of systemic therapy is made in close coordination between the ophthalmologist, the pediatrician, and, if necessary, the rheumatologist.

Treatment of complications

Complications such as cataract or glaucoma may require surgical treatment. Band keratopathy can be treated with special solutions (chelation therapy).

Course and prognosis

A single episode of acute iritis usually heals without consequences under consistent therapy. In chronic or recurrent cases, as occur particularly with JIA, long-term monitoring and treatment are required. The more consistently the inflammation is controlled, the lower the risk of permanent damage.

Our advice

If your child complains of eye pain, light sensitivity, or blurred vision, an ophthalmologist should be consulted promptly. Children with juvenile idiopathic arthritis need regular eye check-ups even without symptoms, since iritis can run a silent and painless course in them.