Review of Optometry
PRESENTS
Practice Pearl of the Week
 
Volume 1, Number 39
January 24, 2011
 

Welcome to Review of Optometry's Practice Pearl of the Week series. Optometrist Paul Karpecki will provide you invaluable clinical information and management strategies for a host of ocular conditions—from dry eye and corneal infection to retinal artery occlusion and neuro-ophthalmic disease.

Here's the second "rule" of iritis management:
 

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.


"Sometimes we all need to realize that negative thoughts have no power. We empower them." – Kurt Goad


 
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