Iritis and now episcleritis

[bobbysox]

Hi
I am currently suffering my third attack of iritis, first July 2007, then march 2008 in alternating eyes. Have just been back to the hospital after 6 days of treatment with Maxidex and dilating drops. Treatment was going well and symptoms had eased until yesterday when eye started hurting and going red again. Doctor says iritis has gone but I now have Episcleritis. I've never heard of this, is this a common development for iritis sufferers? Have been told to continue with Maxidex tapering off over next few weeks and to use ibruprofen. Doctor has told me I need to look at my life and find ways of easing the stress, its stressing me out thinking about how to get rid of stress!! Anyway I would be grateful to hear of anyone else's experinces of iritis and episcleritis. Thanks

[Mike Bartolatz]

welcome to the group.
episcleritis is usually not treated. it can occur along with uveitis in some people with other autoimmune disease processes besides uveitis. NSAIDs are often used to treat uveitis and also for episcleritis and scleritis but Ibuprofen isn't the best one to use. Celebrex, dolobid and naprosyn seem to work the best. episcleritis and scleritis often occur with autoimmune diseases. with the uveitis going from one eye to the other and then possibly back once again the HLA B27 gene should be looked for.
do you have any other health issues going on? rashes? low back pain or arthritis anywhere in your body? Irritable Bowel disease? uveitis is frequently related to the HLA B27 gene which can also predispose to ankylosing spondylitits, reactive arthritis (Reiter's syndrome), psoriatic arthritis, Crohn's disease and ulcerative colitis.
other things can cause this as well from viruses and bacteria and other 'critters' to many autoimmune disease processes. if you have a family history of autoimmune diseases or systemic disease, those things might be the trigger for your uveitis.
often things associated with the HLA B27 gene are triggered by a stomach bug. H pylori for example has been isolated from the fluid in the front part of the eye. there are many other pathogens that could be the trigger.

[bobbysox]

Thanks for your reply. I am not aware of any other health problems going on, I occasionally get a sore neck but have always thought this was as a result of a severe whiplash injury from a car accident, I have had a blood test from my doctor to see if I have arthritis markers but nothing showed up, no rashes , iritiable bowel etc. Will be visiting my G.P. next week so will have a word and ask what exactly I have previously been tested for to see if I was tested for the HLA B27 gene. Other than that I need to look at finding ways of de-stressing my life - yoga perhaps...
thanks

[Mike Bartolatz]

Keep us posted!
Wish you the very best,
Mike

[bobbysox]

Well its a year later and I am still suffering from iritis, the episcleritis did clear up. Since this flare up I have not been able to come off the steroids, each time I taper off the drops it flares back up within a few days. I have therefore been on steroids in my left eye for over a year! I am back at the hospital eye infirmary on Thursday this week and am at a loss what to say to them. I got quite upset last time i was there 2 months ago and told them I felt it was time to stop treating it as an acute condition and recognise that this is now chronic. I really dont know what difference the treatment would be and I dont know what I should be asking for, all I know is I cannot carry on with the endless cycle of drops, flare up , drops..... I need to keep it under control. Can you suggest anything or what I should be asking for, expecting etc from the hospital?

With very many thanks
Lynda

[Mike Bartolatz]

if you are in the UK, please ask for a second opinion by an EXPERT in Uveitis, Professor Ayliffe in London would be who I would ask for or Professor Murray in Bristol or if in Scotland Professor Forrester (sp) their contact information can be found on the SPECIALIST list in the PATIENT information section of http://www.uveitis.org

do you have a history of mouth sores, herpes Sx to be exact? it usually attacks one eye (mostly the left eye) usually one can not taper off the steroids without it coming back. it can cause allot of adhesion between the iris and the lens. holes can appear in the iris too. intra ocular pressure is difficult to keep in normal limits.
if this is the case, then antiviral medications taken orally to put the virus into hibernation are required for the rest of your life. Professor Ayliffe could tell in a few minutes if it is the herpes Sx virus.

H pylori has been found in Fluid of the anterior chamber and it causes very difficult to treat iritis too. this bacteria causes stomach distress which can lead to ulcers. gas can be a symptom similar to Celiac Sprue in some individuals. it can trigger the enteropathic arthropathies which includes ulcerative colitis and Crohn's disease. several new genes have been linked to them, the IL23RN and ERAP1 genes and
ANTXR2 and IL1R2 may also be implicated.

Wish you the very best,\
Mike

[mizzv]

Glad I came across this post. I was beginning to think I was abnormal...I had Iritis for 3 months. Was treated with Dexamethasone orally, and drops. And Atropine. Every time I would taper, it would rebound. Finally, we got it under control. Vision was restored. I returned to work. I work graveyard shifts as a security guard and do my rounds inside as well as outside: rain or shine, snow or hail, etc. Anyhow, after doing a long stretch of work, and not having as much sleep and rest as I'd like....my eye turned red again. I thought it was a flare up of the Iritis. I had almost identical symptoms as a flare up: Red eye, sensitivity to light, soreness in the eyelid crease, headache, and a "pulling" feeling when I moved my eyes. So, I knew to go see my Opthomologist right away. But when I got there, he saw no inflammation inside the eye, but he saw it on the Sclera. And the redness was localized. It was mostly on my inner corner and wrapped half around my iris. The doc says its Episcleritis and gave me Lotemax-loteprednol etabonate ophthalmic suspension 0.5%. Also, the doc says I might wanna rethink getting a new job or scaling back at work. Ideally he wants me to take more time off altogether....but I've already taken 4 months off for Iritis, been back to work 5 weeks....So, I am gonna tough it out for now. But he also mentioned he wants to do a full investigation now. Have already had a MRI-nothing found. So, there was mention of chest Xrays, and spine. But I am glad I found this post....because I was seriously thinking I was the unluckiest person in the world when it comes to my left eye. Mike, can episcleritis turn into scleritis? Also, can it flare up my iritis?

[Mike Bartolatz]

usually episcleritis doesn't become scleritis. it is treated with NSAIDs, celebrex, dolobid or naproxen (otc naproxen at prescription strength. scleritis is treated with steroids and DMARD drugs.
if your vision continues to be photophobic, get in for a recheck. often we notice problems before they show up for the ophthalmologist. steroid eyedrops would then be appropriate. is your uveitis in only one eye?
the first test might be for the HLA B27 gene, then for sexually transmitted disease. if your uveitis is granulomatus, then it would be appropriate to have a chest Xray and Xray of the low back to see if arthritis is starting up.
TB test might also be appropriate. if you have GI problems then the can also look into things like Crohn's disease, ulcerative colitis and Celiac disease. Psoriasis is also linked to this and other conditions have rashes associated with them as well so a dermatological evaluation might be appropriate.
as a steroid sparing approach to iritis not related to a pathogen, often NSAIDs are used as named above. you take them at prescription strength for two years once off all steroids without inflammation.

I do know one lady with an autoimmune disease with scleritis that when treated also had episcleritis present.
scleritis is VERY painful. if you touch the eye it brings on a lot of pain. the odds of you developing scleritis along with uveitis is pretty rare but it does happen.

the red eye associated with iritis starts at the outer ring of the iris and proceeds toward the corners of the eyes. conjunctivitis starts at the corners and proceeds toward the iris.
scleritis is VERY bloody looking. episcleritis just shows red blood vessels.

if you start seeing a lot of floaters or if the aversion to light continues, get back in for an exam. if you start seeing flashing lights get in too as this can be a symptom of a detaching vitreous or retina.

wish you the best,
Mike

[mizzv]

Hey, Mike. Everything got worse over the weekend. Sight went very blurry. I went back to the doctor. He prescribed taking the Lotemax every half hour and Atropine 4 times a day and to see him in the morning. But will see. I took the atropine and my pupil dilated peanut shaped, looked like two pupils connected. Looks like some adhesion going on the same as when i had Iritis. It hurts alot. The whole side of my face hurts.I will go see him in the morning.

[Mike Bartolatz]

sounds like you are in a major flare up of uveitis with the iris sticking to the lens. hopefully they can break the adhesion with more dilating drops. the dilating drop will relax the cilary body and help to prevent pain.

wish you the best,
Mike

[mizzv]

Well, its me again. And a week later, my doctor cannot get the pupil to dilate. We tried Atropine 1%, Mydriacyl 1%, and Phenylnephrine 10%. The doctor tried to put drops in every 3 minutes for 3 hours, and nothing. I got some major adhesion. He said I'm gonna get a needle in my eye tomorrow. Very scared about that. So, if anyone has had a needle in the eye, please comment and let me know what thats like. Also, I'm back on the steroid pills: Dexamethasone 50mg, and predforte every hour. And here's something new and interesting: I had a white cluster on the bottom of my iris. So, naturally, I look it up and it looks like an corneal ulcer....so, I show my doc, and he says its inflammatory cells that settled there. Very interesting. I've been taken prescribed Tylenol #3 for pain. But to be honest, it hasn't helped much. When I look down, it feels like my eye is sprained. I am so photophobic that the doc had to tape open my eye to look in it to get a photo. So, thats my lil update. Sorry if I hijacked someone else' comment box.....:S But to keep in the context of the conversation, I still have episcleritis, but its the least of the doc's worries....he seems pretty worried about the adhesion. So, in turn, that worries me.

[Mike Bartolatz]

I can't recall what the cause of your iritis is? how much of the iris is misshapened by the adhesion between the iris and the lens? let me know what he means by a 'needle in the eye'. is this to inject steroid into the eye or is it to tissue surrounding the eye? did he try cocaine to try to break the adhesion?

I hope the pain can get under control for you quickly. I hate this damned disease!

wish you the best,
Mike

[mizzv]

To answer your questions, Mike. No known cause of Iritis. The doc is gonna do a full investigation now. Already had the MRI months ago for brain-all normal. And I have posterior sychnaie (spelling?) and I had recieved the needle inside the eye. It was steroid injection. The pupil just plain would not dilate at all. But today I got it to dilate a little bit, but it was mishapened a little. The doc has assured me he is consulting with a board, and medical colleagues on my case. The pain has gotten very bad at times-so bad Tylenol #3 (30mg codeine) would not help at all. He even gave me Ativan so that I can sleep through the pain. The injection did help a lot for pain and redness, but I got the injection 4 days ago, and today I've been in so much pain. Basically, I've been in my room all day with my eye shut. Even simple tasks like taking a shower is hard to do. I've been seeing flashes for 2 days, which I have before, and my eye is being monitered on an almost daily basis-my doctor opens his office on the weekend to see me. Tonight, I've been seeing purple splotches on everything-that hasn't happened before.
I agree, this disease is aweful! Not many people seem to understand what it is, and the pain and discomfort it causes.

[Mike Bartolatz]

Please contact professor Ayliffe in London for a second opinion, pay out of pocket if you must but do it right away. you need additional drugs to get this controlled as these complications are very serious that you describe. do any of your immediate family members have a history of systemic disease going on. forms of arthritis? skin rashes anywhere on their bodies? dicolored toenails that could be from psoriasis or sarcoidosis? lung disease? heart disease? neuropathy? dry eyes and dry mouth? GI problems of Irritable bowel disease or celiac disease? a lot of tooth carries?

professor ayliffe can be emailed as well as contacted by phone, his contact information can be found at http://www.uveitis.org in the patient information section of the site on the international specialist list.
there are other specialists on the list within the UK but you have to have referral through your local doctors. the problem is they often won't refer until patients are permanently blinded by their lack of knowledge in how to treat this stuff.
wishing you quiet eyes without pain,
Mike

[mizzv]

Had another injection (5 days after the initial injection)-this time it swelled alot. I can see a little bit better, but everything I see is yellow tinted and still blurry. But before the shot, I couldn't see very much at all (very washed out). Pupil is still stuck to the lens, we got it to dilate a little bit, but its very misshapened and oblong. But just a quick question, I've done research and can't find anything on posterior sychaie and if the dilating drops aren't working. What's the next step? I guess what I'm asking is: how long can I go with my pupil stuck to the lens? And what if the dilating drops just aren't doing the trick? Could they operate?