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Patient with iritis will typically present with a painful red eye and it can sometimes be difficult to tell if it is due to conjunctivitis or a corneal abrasion. Some tips that can help differentiate iritis from other causes of painful red are:
- When pain reduction was used as a diagnostic tool, it had a sensitivity of 80% and a specificity of 86% in determining whether a simple corneal injury was present. In iritis, the pain will NOT be relieved with topical anesthetic.
- In iritis, injection will be localized predominantly around the iris and not diffusely over the conjunctiva.
- The consensual light reflex can be used to make the diagnosis. Of course, shining a light in the affected eye will cause pain, but in iritis shining a light in the normal, unaffected eye (by causing consensual movement of the other affected iris) will cause pain if iritis is present.
Finally, ensure you document:
- Visual Acuity corrected in both eyes. Use a pinhole if they forgot their glasses.
- That you flipped their eyelids to make sure that no foreign bodies are lurking under the lids
- Stain their eyes with flouriscen to ensure there are no corneal abrasions in addition to the iritis.
References
Adapted from Pfaff J and Moore G. Eye, Ear, Nose and Throat. Emergency Medicine Clinics of North America. Volume 15, Issue 2 (May 1997)