A 30-year-old male patient presents with a unilateral red eye and blurred vision in that eye with onset one day ago. The patient is photophobic and has a small pupil in the eye that is red. He denies having any previous episodes. What is going on?

The main ingredients here are recent red-eye, light sensitivity and a small pupil all in the same eye. This sounds very much like anterior uveitis also known as iritis.

Iritis is inflammation of the iris and has several possible causes:

  • Eye injury
  • Infection from bacteria, viruses, parasites, or fungi
  • Inflammatory autoimmune diseases, such as ankylosing spondylitis, lupus, sarcoidosis, and juvenile idiopathic arthritis
  • Injury
  • Reactions to medicines
  • Leukaemia
  • Kawasaki syndrome (lymph node disease in young children).

Eye complications can cause permanent loss of vision:

  • Abnormal adhesion of the iris to other eye structures (synechiae)
  • Cataracts
  • Calcium deposits on the cornea (band keratopathy)
  • Inflammation of the vitreous
  • Inflammation of the retina
  • Optic nerve damage in severe cases, causing blindness
  • Glaucoma
  • Macular oedema.

Recent onset iritis is an ocular emergency and the patient deserves immediate referral to an ophthalmologist.

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