Unusual Iris Inflammation: Why Is Eye Pressure Decreasing?

Atypical iritis, with intraocular pressure not increasing but decreasing???

Hello Doctor: My older brother visited a local ophthalmology clinic last week due to discomfort in his eyes, but he has not been cured.
The doctor suggested it might be iritis and prescribed steroid eye drops to be administered every four hours.
He was asked to return for a follow-up in two days, and the doctor issued a referral to a larger medical center.
Yesterday, we went to a large medical center in the south, where the attending physician stated that this should be iritis, but it does not match the typical symptoms.
There is no history of trauma, no signs of arthritis, no ankylosing spondylitis, and no history of hypertension or diabetes.
The key point is that the intraocular pressure is not elevated but rather decreased.
Therefore, he advised us to go home and administer the steroid eye drops every hour to see if there would be any improvement.
A day has passed, and there are no signs of improvement in the symptoms.
We would like to ask the doctor what direction we should take to find a solution.
Is it possible that this is iritis? Note: Before the illness, his vision was 1.0, but currently, the affected eye's vision is only 0.1.

Poa.Fang, 30~39 year old female. Ask Date: 2010/03/20

Dr. Gao Pilin reply Ophthalmology

Iritis can sometimes lead to a decrease in intraocular pressure during the remission phase.
The uvea is divided into three parts: the iris, the ciliary body, and the choroid.
When inflammation occurs in the anterior part of the uvea, specifically in the iris, it is referred to as "iritis." If the inflammation affects the middle part of the eye and involves the ciliary body, it is called "cyclitis." If the inflammation is located in the posterior part of the eye in the choroid, it is termed "choroiditis." If the doctor has informed your brother that he has iritis, it likely indicates anterior inflammation, and with proper treatment, vision is usually not significantly affected.
I wonder if the doctor has prescribed atropine or similar eye drops, which can cause pupil dilation and blurred vision.
If the condition is caused by a virus, it may potentially affect the retina and impact vision.
Treatment for iritis with eye drops will not lead to immediate improvement, so please follow the doctor's instructions regarding medication and follow-up visits.
If you are visiting a major medical center in the southern region, it is best to choose a specialist in uveitis.
In the south, you can consult Dr.
Chiu-Tung Chuang at Kaohsiung Veterans General Hospital.
If you wish to go to Taipei, you can see Dr.
Yu-Mei Chang at Veterans General Hospital or Dr.
Chang-Ping Lin at National Taiwan University.
Wishing your brother a speedy recovery.

Reply Date: 2010/03/20

More Info

Iris inflammation, or iritis, is a condition that affects the iris, the colored part of the eye, and can lead to a variety of symptoms including pain, redness, light sensitivity, and blurred vision. In your brother's case, the diagnosis of iritis was made, but the unusual finding of decreased intraocular pressure (IOP) is indeed atypical, as iritis often presents with elevated eye pressure due to inflammation.

1. Understanding Decreased Eye Pressure: In typical cases of iritis, inflammation can lead to increased eye pressure due to swelling and blockage of the drainage pathways in the eye. However, in some instances, particularly when there is significant inflammation or damage to the structures within the eye, the pressure can drop. This can occur if there is a loss of aqueous humor production or if the drainage pathways are compromised in a way that does not allow for normal fluid dynamics. It’s also possible that the inflammation is affecting the ciliary body, which produces the aqueous humor, leading to decreased production and, consequently, lower eye pressure.

2. Next Steps for Management: Given that your brother's symptoms have not improved after one day of treatment with steroid eye drops, it is crucial to follow up with the ophthalmologist. The physician may consider additional diagnostic tests to determine the underlying cause of the iritis and the unusual eye pressure. These tests may include imaging studies or blood tests to rule out systemic conditions that could be contributing to the inflammation. If the inflammation is not responding to steroid treatment, other medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) or immunosuppressive agents, may be considered.

3. Potential Causes of Iritis: Iritis can be caused by a variety of factors, including autoimmune diseases, infections, trauma, or even idiopathic origins where no clear cause is identified. Given that your brother does not have a history of systemic diseases or trauma, it may be worthwhile to explore potential infectious causes or other underlying conditions that could be contributing to the inflammation.

4. Monitoring Vision: The significant decrease in visual acuity from 1.0 to 0.1 is concerning and warrants immediate attention. Vision loss can occur due to complications from iritis, such as the development of cataracts, glaucoma, or retinal issues. It is essential to monitor any changes in vision closely and report them to the healthcare provider.

5. Importance of Follow-Up: Continuous follow-up with an ophthalmologist is critical in managing iritis, especially when symptoms do not improve. If the current treatment regimen does not yield results, the physician may need to reassess the diagnosis and consider alternative treatments or referrals to specialists, such as a uveitis expert.

In summary, while decreased eye pressure in the context of iritis is unusual, it is not impossible. The next steps should involve close monitoring, further diagnostic evaluation, and possibly a reassessment of the treatment plan. It is essential to maintain open communication with the healthcare provider and report any changes in symptoms or vision promptly.

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