Rule 2. Determine the severity.
Based on last week's pearl, you’ve already ruled out a keratouveitis. So now, you need to determine how you will
manage the iritis. Generally, the severity of an iritis can be determined by addressing these five questions:
- Unilateral or bilateral?
- Keratic precipitates (KPs) present on the endothelium?
- Synechiae present?
- Grade 3+ (or higher) cell and flare or the presence of a hypopyon?
- Number of occurrences?
If two or more of the major findings are present, you should order a medical work-up and laboratory testing to rule out
an underlying systemic disease cause (we'll discuss lab work in a future Pearl of the Week). For example, if a patient
presents with a bilateral iritis, KPs on the endothelium and a hypopyon, it is best to recommend a medical work-up or
order a battery of lab tests. Or, if you see a patient with synechiae and KPs, and this is the second occurrence of
iritis in his or her given eye, then a lab work-up is recommended.
Remember, the presentation's severity provides clues to the potential existence of an underlying systemic cause.
And, until that systemic cause is diagnosed and treated properly, an affected patient always is at risk for ocular
complications secondary to associated inflammation.
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