17: Eye Irritation

A 47 year old man presented to the ED with left eye irritation that had been present for about two weeks. He denies trauma, headache, discharge and vomiting but does have some degree of photophobia and slightly blurred vision that seems to clear when he blinks. On exam you note injection without discharge. Look closely at the image. What type of conjunctivitis does he have?

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ANSWER:
No type of Conjunctivitis! This is Iritis.

Distinguishing characteristics of iritis include consensual photophobia (may be absent when not acute), limbal flush (intense injection in the bulbar conjunctiva adjacent to the cornea), cell and flare on slit lamp, and posterior synechiae in chronic cases (if you look very carefully at the image you may notice that tjere are bands of adhesions that connect the posterior iris to the lens). This case was due to neurosyphilis and you can’t cure that with eyedrops.

Iritis from “Quick Essentials: Emergency Medicine“

Findings:   Consensual photophobia, Limbal flush, hypopyon, irregular pupil, cell/flare
Tests:        Fundi to r/o retinal invlovement, IOP, <50% relief ĉ tetracaine,
Cx:            Idiopathic > trauma, sarcoid, TB, IBD, corneal ulcer, HSV, Lyme, Syphilis…
Treatable: HIV, VZV, CMV, TB, Lyme, STD’s, leukemia, autoimmune
Rx:            Ophtho f/u <24h. Pred-Forte q 1h, sunglass, homatropine.  Rx ^IOP