I've got it again!

[The Arty One]

Hello Mike!

Apologies for not posting as a separate topic. I really appreciate your quick reply as I feel a bit alone in dealing with this (noone else I know has had this).

Oh dear I must tell my G.P to refer me to a specialist, the eye clinic doctor would barely have spoken to me if I hadn't have asked any questions.
I honestly don't know if I have inflammation of the Vitreous or inflammation along the pars plana. I just got told I have cells floating on my iris. I suspect I have flare. After reading other peoples experience of Iritis I feel like I am different in that I hardly get any symptoms when I get Iritis. To be honest I don't even have much photophobia, apart from discomfort when it is sunny and my eyes have recently been dilated. I don't wear glasses, but I have started to wear shades when it is sunny as my dilated pupil is vulnerable to UV rays. Though none of the several doctors I've seen in the past have even suggested that I take steps to protect my eyes. I must get some wrap around sunglasses like you said.

I've been put on dilating drops twice a day and Pred Forte four times a day, (one drop in the left eye). I was on Pred Forte every hour when I got it last time so i assume it isn't quite as bad.

This is my action plan... hehe...
I have a review appointment on Monday where I am going to ask for a copy of my notes, a referral to the specialist (hopefully William Ayliffe in London) and blood tests to rule out any underlying illness/condition. Can you think of anything else I should be aware of/ do? I feel a lot better about things after finding this forum x

[Mike Bartolatz]

Switchboard: 020 8401 3000
Appointments: 020 8401 3128
Mr Ayliffe sec: 020 8401 3130

above are the NEW telephone numbers for Mr William Ayliffe in London.

if the inflammation is primarily in the Ciliary body/pars plana or posterior segment, there would be little to no pain, redeye or photophobia. Testing would be guided by input from Mr Ayliffe after your consultation giving him pertinent personal and family medical history. we have a Patient questionaire that you can flill out and present to your doctors by the way. take time with your parents and fill it out completely, make copies and then present it to your doctors.

you will have to get the 'fit over' sunglasses through the internet as everyone from the UK who has posted here has had to do so. the 'SOLAR SHIELDS" like has been used by others. If dry eyes are an issue, then you can get fit over motorcycle sunglasses that have a foam gasket between the frame and the face. some have several colors interchangeable lenses. if you need help finding the links, let me know and I'll get them for you.

wish you a fantastic Holiday Season,
Mike

[The Arty One]

Hi Mike, hope you are well. Forgive me if I sound ignorant but I don't know what the iliary body/pars plana or posterior segment are! If I have inflammation there is that worse/ better or the same? I look forward to getting my notes from the past so I know what is going on properly. I refuse to let this get me down but I also need to make sure I'm getting the right treatment.

Have a lovely weekend Mike x

[Mike Bartolatz]

http://www.uveitis.org/patient/glossary/default.html

Above is a link that will explain the terms related to the eye with a diagram.
the eye is divided into three segments, the front from the iris to the cornea is called the anterior Segment; the part from the iris through the ciliary body and the front part of the vitreous humor (the jelly like substance that fills the eye) is called the intermediate segment; the back part of the vitreous and the macula, retina, optic nerve and the choroid is called the posterior segment. Therefore, there are three segments all of which have the Uveal tract (blood vessels that nourish the eye). three types of uveitis, anterior, intermediate and posterior. one can have inflammation in just one segment or two or all which would then be called Pan Uveitis..

the ciliary body produces the fluid inside the eye, has the job of opening and closing the iris which is attatched to it through the Zonules. it is composed of the pars plicata and the pars plana. the pars plana is the outermost part of the ciliary body just adjacent to the retina. material from the uveal tract can 'exude' from it forming what looks like 'snowbanks'. cells can enter the vitreous along with protein (flare) and floaters (cells and fibrin sloughed off from the vitreous membrane which is transparent and seperates the vitreous from the retina.

one can have intermediate uveitis which will 'spill over' into the anterior chamber causing problems with iritis. this is called iridocyclitis in Most instances. but doesn't have the exudate, just cells and flare in the vitreous. some Schools of medicine call this iridocyclitis anteriour uveitis. this will produce some red eye and photophobia,
in some cases just the pars plana is infalmmed with exudate and cells and flare are present in the vitreous yet this doesn't produce red eye or photophobia.

posterior uveitis doesn't cause pain or photophobia in many cases. it doesn't cause red eye.

sometimes the 'red eye' isn't caused by the uveitis but is caused by several other things. conjunctivitis can be caused by allergy pathogen or autoimmune disease and trauma (dry eyes causing the eyelid to abraid the cornea and conjunctiva).
episcleritis and scleritis are autoimmune in nature often related many of the autoimmune disease processes.

When reading, I suggest that you open up the Glossary of Medical terms link above and switch back and forth to it when needed so that you understand what doctors tell you or what you are reading here or elsewhere on the internet.

I hope this helps,
Mike

[The Arty One]

Thanks Mike, that is useful reading!

[The Arty One]

After 10 days of taking Pred Forte 4 x a day my doctor tells me I am in remission and am now tapering off the drops slowly over the next month. I am so pleased and relieved, I asked if there is any damage that can be seen in my eye and there is none. I only need to take the dilating drops at night over the next week and then will stop them completely. I have been getting some lower back pain, aching wrists and shins (odd as I'm only 26) and will see my G.P to ask for blood tests to make sure I don't have any arthritis. But in terms of my eyes I am okay, it must have been a very mild case.

Thanks Mike for the advice, and also for informing me about Iritis as I didn't know enough about it previously.

Wishing you all a lovely festive season x

[Mike Bartolatz]

With uveitis and arthritis pain, the tests to get are HLA B27, ANA, RF as well as CRP and Sed rate.
if HLA B27 or ANA pos with RF factor it would be time to thing about adding NSAIDS since the likelihood of re occurance of eye inflammation is pretty great.

Wish you a successful taper off of the drugs,
Mike

[The Arty One]

A quick update as I'm unsure of what to do. Monday was the last day I took my eye drops, I completely tapered off the drops as told to. Last night I noticed that in the dark my left eye had better vision than my right eye (?!). I woke up with really bad photophobia and never would have believed it could come on so quickly. I had some blood tests with my GP and my RF blood test came back slightly abnormal.

I am gutted as I will be starting a new job in January and am moving away so any help please!

[Mike Bartolatz]

Call your opthalmologist and ask to return and if it gets worse ask if you should restart the corticosteroid eyedrops. it sounds like it is time to see a true expert and stop the recurrent beast before you lose significant vision and implement a corticosteroid sparing approach to treatment.

wish you hte best,
Mike

[The Arty One]

Hey Mike

Yeah I got myself down to an opthamalthist (spelling?!), and though it took a long wait at the hospital I saw a good doc and am back on the drops. He listened to my concerns but said I do really need to take the drops, treatment is 6x pred forted for a week and 2x day dilating drops for a week. Then I'll be tapering off after a one week consultation to make sure all is going okay.

Doctors here in the UK don't seem to think about a steroid sparing treatment which is annoying, but on the bright side my photophobia isn't as bad as it was this morning. Thanks Mike for listening x

[Mike Bartolatz]

Many doctors here in the USA don't know how to implement a corticosteroid treament approach and that is why I try to get people to see true EXPERTS in the diagnosis and treatment of Uveitis. there are specialists there in the UK who can implement a steroid sparing approach. MS Stavarou and MR Ayliffe are examples of such fellowship level trained ocular immunologists in the UK. Even MS Lightman can do this as can Doctors elsewhere. the squeeky wheel gets the grease. to allow a steroid only approach to treatment to occur will result in just that, nothing else and possible loss of vision to glaucoma, cataract or other changes within the eye such as epiretinal membrane formation, cysoid macular edema or worse, destruction of the optic nerve from glaucoma resulting in blindness.
contact information is in the Specialist list at http://www.uveitis.org
believe me, I have had most of the above complications. life with diminished vision isn't fun.

Mike

[The Arty One]

I spoke to my GP a few days ago and my RF was okay but my ANA was positive. Alone it could mean nothing, but with my iritis and other symptoms I will be referred to a specialist. My problem is have now moved so need to re-register with a new doctor and get them up to speed. I am also nervous as I am gong to a different hospital for my Iritis review, fingers crossed that it has cleared and I can start tapering off these awful drops.

The dilating drops have been stinging my eyes more than usual so I am desperate to get off them, also I want to read a good book lol

Hope you had a great christmas!

[Mike Bartolatz]

often the reason for the stinging from eyedrops is caused by poor tear film.

afer instilling your prescription eyedrops, wait about 15 minutes and then instill a good brand of LUBRICATING eyedrop to help return the surface of the eye to a more normal condition. the single use disposable vials of the lubricating eyedrop are suggested because the frequent use of the corticoseroids and dilating drops cause a problem because of the preservatives used in them that over time caus an almost allergic reaction to them.

once again, why not see if Mr Ayliffe can become your opthalmologist.

Wish you the best,
mike

[The Arty One]

Thanks for the quick reply, yeah I think you're right as my eye feels a little dry in the morning. I shall pick up some lubricating drops tomorrow, my appointment today went well and the hospital was far more efficient than the previous hospital I went to. The doctor said I can taper off the drops slowly like before and has given me another appointment in three weeks.

I am going to try to see either Mr Ayliffe or Ms Stavrou as Birmingham is closer to me. I hope it all goes alright, and this site has helped immensely!

[Mike Bartolatz]

I hope that this can be stopped soon for you, glad the 'new' local is more efficient than the 'old' one too. Lets hope they will refer for you to see a true specialst and get you on a steroid sparing approach to help prevent development of long term coritcosteroid use such as cataract and glaucoma.

Happy New Year.
Mike