Iritis

Overview

Iritis (say eye-RYE-tis) is inflammation of the iris — the colored ring at the front of your eye. It is a type of uveitis, which means inflammation of the middle layer of the eye. Inflammation is your body's reaction to injury or illness. In iritis, the eye becomes sore, red, and sensitive to light. It is not the same as a simple red eye from tiredness or a cold, and it needs to be checked by an eye professional.

Iritis is not one of the most common eye problems, but eye clinics see it regularly. It is a well-known reason for a painful red eye.

Anyone can get iritis at any age. It is most often seen in adults aged 20 to 50, but children can get it too — especially children with juvenile idiopathic arthritis (JIA), a type of childhood arthritis. People with conditions where the immune system attacks the body's own tissues have a higher chance.

Symptoms

Common symptoms

• Aching eye pain, often worse when you look at bright light
• Redness, especially around the colored part of the eye
• Sensitivity to light (photophobia) — bright light hurts or makes you squint
• Blurred or cloudy vision
• Tearing or a gritty feeling in the eye
• A pupil that looks smaller than usual or different from the other eye
• Symptoms often start over hours or days, and may affect one eye or both

Symptoms in children

• Children may not say their eye hurts, so watch for changes in behavior
• Red eye, tearing, squinting in bright light, or rubbing the eye
• Blurred vision or a pupil that looks different
• Children with JIA can have iritis with no symptoms at all, which is why regular eye screening matters

Symptoms in older adults

• Older adults may put eye redness or blurred vision down to aging or dry eye
• Iritis can still happen and can be confused with other serious eye problems such as glaucoma (raised pressure inside the eye)
• Get same-day advice for a painful red eye, especially with light sensitivity or vision changes

Causes

Main causes

• Often no clear cause is found. The immune system, which normally fights infection, may mistakenly attack the eye.
• Conditions where the immune system attacks the body's own tissues, such as some forms of arthritis, Crohn's disease (a bowel condition), ulcerative colitis (another bowel condition), and psoriasis (a skin condition)
• Infections, including some viral infections such as shingles or herpes, and some other infections
• Eye injury or eye surgery
• Sometimes it is linked to another eye problem or to medicines, but this is less common

Risk factors

• Having an autoimmune or inflammatory condition
• A family history of autoimmune disease or certain gene types
• Smoking
• Eye injury
• Being a child with juvenile idiopathic arthritis (JIA) — these children need regular eye screening even if their eyes feel fine
• Having had iritis before

When to see a doctor

See a doctor urgently if:

• You have new eye pain, redness, or light sensitivity — get same-day advice
• Your vision becomes blurred or cloudy
• You have a known autoimmune condition and notice any eye change
• Your child has JIA and has eye redness, pain, or vision changes
• Symptoms come back after treatment — do not wait for a routine appointment
• You have eye symptoms after an injury or while wearing contact lenses

Book a routine appointment if:

• You have a scheduled follow-up for iritis, even if you feel better
• You have questions about your eye drops or side effects
• You are at higher risk and need regular eye checks
• You want advice about preventing eye injury at work or during sport

Diagnosis

A doctor or eye specialist diagnoses iritis by examining your eye with a special microscope called a slit lamp. They look for signs of inflammation inside the eye, check your vision and eye pressure, and ask about your health. Because iritis can be linked to other conditions, they may arrange blood tests or other checks.

Tests that may be done

• Slit-lamp eye exam — a bright light and microscope are used to look inside the eye
• Vision test
• Eye pressure check
• Exam of the back of the eye after dilating drops
• Blood tests or other tests if your doctor thinks an underlying condition may be involved

What to expect at your appointment

You may be seen in an eye clinic, sometimes the same day. The eye doctor will put drops in your eye to numb it and to widen the pupil. The light from the microscope can feel bright, but the exam is quick. You may need blood tests if a cause is suspected. You can usually go home the same day.

Treatment

The goal is to calm the inflammation quickly, ease pain, and prevent lasting damage. Treatment is usually arranged by an eye specialist, often the same day. Most people use eye drops for several weeks and are checked regularly.

Self-care at home

• Use your eye drops exactly as your care team shows you. Do not skip doses or stop early without asking.
• Wash your hands before and after putting in drops. Keep the bottle tip clean and do not let it touch your eye.
• Do not rub the eye.
• Wear sunglasses if light bothers you.
• Avoid contact lenses while the eye is inflamed unless your eye doctor says it is safe.
• Do not drive if your vision is blurred or you feel unsure.
• Keep follow-up appointments even if you feel better.

Medical treatments

Treatment aims to calm inflammation, relieve pain, and protect your vision. You may be given medicated eye drops — for example, drops to reduce inflammation and drops to relax the pupil and ease pain. Sometimes tablets or other forms of medicine are needed if drops are not enough. Your care team will explain what each medicine is for and how to use it. Do not use old eye drops or someone else's drops.

When is surgery considered?

Surgery is not usually used to treat iritis itself. It may be needed later if iritis causes problems such as cataracts (clouding of the lens) or glaucoma (raised pressure inside the eye) that do not respond to other treatment. Your eye specialist will discuss this if it applies to you.

Living with this condition

You may need to use eye drops several times a day at first and go to follow-up visits. Plan for light sensitivity by keeping sunglasses handy. Tell your employer or school if you need breaks or time off for appointments. Ask for help with driving if your vision is blurred.

Lifestyle tips

• Do not smoke, and get support to quit if you smoke.
• Protect your eyes from injury at work or during sport.
• Keep hands clean and do not share eye drops or eye makeup.
• Manage stress and get enough sleep — this is not a cure, but it helps you cope.
• Keep other health conditions, such as autoimmune disease, under review with your care team.

Diet and exercise

There is no special diet that cures iritis. A balanced diet and regular movement support general health and may help with inflammation linked to other conditions. Ask your care team what activity is safe for you. If bright light bothers you, outdoor exercise with sunglasses may be easier.

Mental health and emotional wellbeing

Eye pain and changes in vision can be worrying, and repeated flares can feel tiring. It is normal to feel anxious or low. Talk to your care team about support. If you feel overwhelmed, hopeless, or are having thoughts of harming yourself, contact your local crisis service or emergency services right away. If you are in immediate danger, call your local emergency number.

Prevention

Not all cases can be prevented. You can lower some risks by not smoking, protecting your eyes from injury, keeping autoimmune conditions managed with your care team, and getting eye symptoms checked quickly. If you are at high risk, regular eye checks can catch problems early.

Vaccines

There is no vaccine for iritis itself. Some infections that can trigger eye inflammation can be prevented by routine vaccines. Ask your healthcare provider which vaccines are recommended for you.

Screening programmes

There is no general screening test for iritis. People with certain autoimmune conditions — especially children with juvenile idiopathic arthritis — may need regular eye checks even when their eyes feel fine. Ask your care team if you need eye screening.

Complications

If left untreated

• Scarring inside the eye, where the iris sticks to the lens (synechiae)
• Raised pressure inside the eye (glaucoma), which can damage the optic nerve
• Cataract — clouding of the lens
• Swelling in the back of the eye (macular edema), which can blur central vision
• Long-term or permanent vision loss

Long-term outlook

With early treatment, most people do well. Some people have more than one episode, and a few need long-term eye care. Keeping appointments and getting help quickly for new symptoms gives the best chance of protecting your sight.

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