HEAD, EYE, EAR, NOSE, AND THROATEMERGENCIESIritis/Uveitis
ETIOLOGY
■ Inflammation of the iris or uveal tissue
■ Iritis (also known as anterior uveitis) is most commonly caused by trauma.
■ Uveitis can be caused by autoimmune disease, infection, surgery.
SYMPTOMS/EXAM
■ Photophobia is a hallmark symptom.
■ Decreased visual acuity, injected sclera
■ Slit lamp cells and flare seen in anterior chamber (like dust particles mov-
ing through a movie projector beam).
■ Can be unilateral or bilateral
■ Painful
TREATMENT
■ Mydratics
■ Analgesics
■ Treat infection, if present
■ Consider steroids with ophthamology consult.
Optic Neuritis
ETIOLOGY
■ Idiopathic
■ Multiple sclerosis (accounts for 25% of optic neuritis)
■ Sarcoidosis
■ Leukemia
■ TB
SYMPTOMS/EXAM
■ Unilateral vision loss
■ Pain with EOM
■ Afferent pupillary defect
■ Optic-disk swelling, optic nerve pallor may be seen or exam may be nor-
mal (see Figure 14.40).
TREATMENT
■ Ophthalmology consult
■ MRI to rule out multiple sclerosis
Temporal Arteritis
ETIOLOGY
■ Asegmental vasculitisthat can affect various branches of the HEENT
area (eg, ophthalmic, vertebral, temporal; see Figure 14.41)
■ Usually age >60 years old
■ Typically women > men
People with iritis have
photophobia because light
causes the iris to move.Optic neuritis: “The patient
sees nothing and the doctor
sees nothing.” (Nothing
abnormal on examination of
the eye.)Optic neuritis = rule out
multiple sclerosis.