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Re: My story of iritis-2 weeks in

Posted: Fri Jun 15, 2012 6:01 pm
by mizzv
Thanks, Mike. I told the doctor about the head pain, and I got the okay to still take Tylenol but the doctor gave me another prescription for Tecta 40mg, a pill to take daily to coat my stomache lining so that I do not get an ulcer. Since I will be doing a very slow taper, I will be on steroids for a while longer. So, the Tecta will just be a preventative for now.
My GP thinks that the scalp pain is referred pain. But I didn't have pain in my eye that evening, so maybe not. But she is sending me to another opthmologist for a second opinion.She said she just wants him to take a look at my eye, but she said I don't need to commit to him as a patient. Just better to be safe than sorry.
Last night I thought I relapsed my own eye: I rubbed my eyes and had lots of pain all night in my left eye and socket. But I took the steroid drops when I woke up and it is fine now. I think I may have just agitated the eye.
I asked the GP about an ocular immunologist, but she said we don't have one around here. So, I guess for now I will have to stay in the hands of opthmologists.
I noticed that many of the diseases and infections that can cause Iritis all have some syptoms similiar to another disease that could cause it. Seems like it can be hard to diagnose. But the next step for me is blood work. So, maybe that will find the cause or at least get us another step closer.

Re: My story of iritis-2 weeks in

Posted: Fri Jun 15, 2012 7:47 pm
by Mike Bartolatz
yes the doctor would have to rule out all the things most often related to this.
HLA B27, sed rate, C reactive protein etc to measure inflammation. a test for TB and sexually transmitted diseases and perhaps a LYME disease test. if you have pets, then cat scratch disease, toxocara canis or toxocara catis, leptospirosis etc. then Anti Nuclear Antibody test would be ordered and RF factor.
to look for autoimmune stuff.

wish you the best,

Re: My story of iritis-2 weeks in

Posted: Fri Jun 15, 2012 7:50 pm
by Mike Bartolatz
if you have stomach problems, get checked for H pylori which was found to be present in fluid inside the eye in 40% of individuals in one clinic.
the other option if only one eye is herpes Sx. a trial of acyclovir taken orally might help get a diagnosis if it could possibly be herpes Sx related.

just my thoughts,

Re: My story of iritis-2 weeks in

Posted: Wed Jun 20, 2012 7:28 pm
by mizzv
Well, remember how I mentioned before that a couple weeks before I had Iritis, I had a tootheache that lasted a week. And mysteriously disappeared? Well, its back! But this time it is on the top back gums and gums are very swollen in back of teeth. Also, my tonsils feel a bit sore and swollen. So, I mentioned all this to my opthmologist and I am going to see a dentist tomorrow. The opthomologist says this can very well be related to the Iritis. He said its either infection or another symptom of autoimmune disorder. But I hope to know tomorrow what they see with my teeth. I also have my second opinion opthmologist tomorrow, too. I woke up this morning in immense pain in my teeth and eye at the same time. But when I got to the doctor and they dilated my eye and took photos, he didn't see any inflammation. But my eye is still red, blurry vision and pained. So.....if its not inflamed.....I'm confused.

Re: My story of iritis-2 weeks in

Posted: Wed Jun 20, 2012 8:24 pm
by Mike Bartolatz
periodontal disease is often related to the TH17 pathway of inflammation. this can also cause uveitis to occur by illiciting the production of IL17A and TNF A. both inflammatory compounds made by the immune response.
can you get to an Ear Nose and Throat doctor for evaluation? might be better at connecting the dots than a dentist unless it is A DMD, a physician that treats dental problems.
often we know we are about to have a major bout of inflammation before the doctors can see it through the slit lamp microscope.
if your eye is painful on the white part of the eye, it might be Scleritis causing pain. orbital pain is of concern too especially if there is swelling which might be cellulitis. viruses and other pathogens can cuase this to occur as well as systemic disease.
temporal arteritis can also cause scalp pain because of giant cells present as well as temple pain and it can be linked to uveitis.

Wishing you the best,

Re: My story of iritis-2 weeks in

Posted: Wed Jun 20, 2012 8:49 pm
by mizzv
Thanks Mike, you never cease to amaze me with your wide wray of knowledge. I am writing all this down to ask the dentist and opthmologist tomorrow. It seems like they both see so many other things that they have a hard time linking my symptoms to anything. Example: I tell my opthomologist that for the past couple nights I've been seeing flashes that last about 20-30 seconds. I only see the flashes in a dim room and I would compare it to the field of vision test, just the flashes were bigger. They were about 3 round circles that flashed. My opthmologist tells me its normal. Now, my dilated pupil (from Atropine) is distorted. It looks like my iris is leaking into the pupil in some areas. Um.....I can't just go through life with all these normalcies. I know I am no expert....and I do believe that the doctors may have some experience with this. But I am just frustrated with all these experst telling me "its normal". So, my poor "second-opinion opthmologist" is going to get a bunch questions tomorrow. I am tired of not knowing what is happening in my body. Living in chronic pain is not normal. I am bringing in a list of my symptoms: from toothe ache, to lesions on my skin, to flashing lights, pulsating eye, and IRITIS. I am also bringing in my own questions and remarks. And I will have a notepad to take notes. I am normally not a pushy person, but I owe it to my eye. Thank goodness for you, Mike and your forum. I feel like I can relate to everyone's stories and really am happy for all your information. Feels like I'm not alone.

Re: My story of iritis-2 weeks in

Posted: Thu Jun 21, 2012 5:14 pm
by Mike Bartolatz
your pupil isn't distorted from atropine, it is distorted from ADHESION between the iris and the lens.
dilating drops cause a perfectly round dilated pupil in a normal eye.
the cells from inflammation act like glue and glue the iris to the lens in some individuals. the reason you are taking the dilating drop is to keep the iris open so that if it does adhere, it will be in an open position. not that it is adhered, it may not completely close when you are no longer on the atropine. the atropine relaxes the cilary body which goes into spasm when it can't open and close properly.

you mentioned skin rash, where is it and describe it to me.
have you had a dermatological consultation to identify a cause of the rash?
often psoriasis is linked through HLA B27 and the IL23R and ERAP1 genes.
sarcoidosis has possible link through pimple like rash on the face as well as a type of rash on the face that is areas of swelling about the size of a pea but not that high just under the skin. rashes on the lower legs occurs called erythema nodosum (this occurs in other things too usually granulomatous disease like wegener's granulomatosus, crohn's disease and the herpes Sx virus).
a butterfly like rash on the face is a symptom of Lupus, Systemic Lupus Erythematosus.
rosacea often occurs on faces of people with autoimmune conditions.
severe dry mouth is linked to sjogren's syndrome, SLE, sarcoidosis, and all can have severe dry eyes associated with them.
the HLA B27 arthropathies can also have dry eyes.
a lot of cavaties suggests possible sarcoidosis or Sjogren's syndrome or SLE.

you sound like you have a lot of adhesion going on between the iris and lens. this is often seen in granulomatus uveitis seen with the things above, as well as Herpes Sx uveitis and brucellosis (sp).

I hope the second opinion doctor will be able to help you sort this out.

take care,

Re: My story of iritis-2 weeks in

Posted: Fri Jun 22, 2012 6:28 pm
by mizzv
Hi, Mike.
I went to my second opinion doctor and my iris was still definetly was not round. It was shaped like a heart. The doctor did a full assessment and asked plenty of questions. Then he did an eye exam with round rings that looked like magnifying glass. He looked into my pupil at almost every angle. So, afterwards he read out his full report onto a tape recording device. This is what I heard: "28 year old female presents a case of Acute Non-Granulomateus Iritis. Observed white cells in the aterior chamber...spillover.....patient suspects she has had rosacea for a few months due to broken capillaries on her nose and cheeks and also flare ups of inflammation of facial derm, patient has had lower back pain on and off for years. Also, has had shoulder pain and neck pain sitting in certain positions. Patient also has recent tooth pain, however it is on the right side which is going to be assessed by a dentist later today. Patient has been experiencing headaches Iritis occured along with pain in scalp, cheek bone, eye brow bone and forehead. When asked about arthritis, patient suspects that she has arthritis in fifth fingers( pinkies).....patient has not been assessed for Ankylosing Spondylitis. My recommended treatment would be to use atropine once per day, Preforte every hour. Patient is now on Atropine every 4 hours, Mexadex every 2 hours and Dexamethasone 50mg"
I discussed my pupil with him and he said it is probably scarring. But today, when I used the atropine and the pupil is alot rounder today. I think your right on that one, Mike: adhesion. I hope its nothing serious.

So, afterwards I went to the dentist. the dentist seen that I have a wisdom tooth with no more room to grow, and it pushed on my other teeth which made my gums form a pocket and bacteria collected inside it and caused infection. Being on the steroids, my body couldn't fight the infection well. So, the dentist extracted the wisom tooth. He said it is possible that if I have an autoimmune disease that it may have rushed the swelling in the gums to form the pocket. But he said the wisom tooth would have had to be extracted sooner or later anyhow.

The rashes you inquire about Mike are well....I'm not sure if its considered rash. But right before the Iritis, I had an outbreak on my jawline of red hard pimples that wouldn't go away for months. My mother in law gave me some retinol cream from her dermatologist and it helped clear it up. I have red broken vessels on my nostrils and top of my nose bone, also in my cheeks. And when my skin flares: I get small red dots appear below my cheeks. I asked the eye doctor about my open pimples that will not go away on my face....they are looking like open sores. He says its the steroids: they can cause acne and the healing process is very slow because my immune system is supressed.

Re: My story of iritis-2 weeks in

Posted: Sat Jun 23, 2012 6:06 pm
by Mike Bartolatz
it is time to contact dr Deschenes in Montreal for a consultation and pay out of pocket if you must. the amount of steroid you are on indicates that there has to be a lot of inflammation present and you are now having infection of your gums with potential for the infection to get into your jaw. are you on antibiotics to stop the infection from spreading to other tissue?
you need a dermatologist to look at the rash on your face to see if it is regular acne or if it could be lupus pernio (google picture of this).

you will need to get a rheumatologist involved too in order to have someone who can use DMARD drugs to treat this stuff in a steroid sparing approach to treatment.

Wish you the best,

Re: My story of iritis-2 weeks in

Posted: Fri Jun 13, 2014 7:44 am
by Frspt74
I know this thread is pretty dated now.....but I have been suffering EXACTLY the same the letter! Just wondering if there was any resolution / difinitive diagnosis? I have stumped every doctor and specialist so far as everything comes back normal. They can see there is something obviously wrong..but can't find a what or why. I do have crohns disease..and they are leaning towards this being optic neuritis....but there is no evidence of the optic nerve being inflamed / damaged. This has been going on for the last 6 weeks in my left eye...the right eye for the last 2 days is now starting to become painful / red as well. Very frustrating!!

Re: My story of iritis-2 weeks in

Posted: Fri Jun 13, 2014 1:22 pm
by Mike Bartolatz
crohn's disease is a cause of granulomatous uveitis/iritis/intermediate uveitis/parsplanitis/posterior uveitis and optic neuritis. I STRONGLY urge you to get a true expert involved in your care as it can be extremely difficult to control uveitis linked to crohn's disease. often DMARD drugs along with TNF A blocking drugs are required to stop the inflammation. the Crohn's has to be controlled to prevent re occurrence of inflammation inside the eyes. one can also exhibit inflammation of other systems of the body to include the lungs, heart, kidneys etc.
I don't know where you live so PLEASE tell me and I will suggest the closest Ocular Immunologist for you.

steroids are used to put out the fire of inflammation and then other classes of meds are used to keep it quiet in the eye. this can be a very long journey that you are starting and the sooner you start the steroid sparing approach, the better the outcome for you eyes and other systems of the body.

Wishing you the very best,
Mike Bartolatz

Re: My story of iritis-2 weeks in

Posted: Tue Oct 30, 2018 9:55 am
by Avalee
Dear Mizzv and Mike,

I am so glad to find this forum and this thread, I just hope you still monitor it.

I have been diagnosed with intermediate uveitis although there are 0.5 cells at anterior chamber. The main symptom is the membrane-like floaters with occasionally flashes. I was prescribed Pred Forte from once every hour and taper down every week, and Mydriatic three times a day tapered down to once a day and stop after three weeks. The consultant reckon I got Fuch's due to the presents of Keratic Precipitates (KP) he has found and the fact I have only got one eye affected. If it's due to autoimmune, then both eyes shall be affected as he said.

My full blood test 6 week after I started treatment showed a reduced level of WBC and neutrophil. CRP, ESR, ACE, Liver, kidney function, blood born virus (BBV), immunoglobin test are all negative. ANA, ANCA and RF are also tested and are fine. However, the FBC are normal after another 3 weeks.

About 8 weeks after starting treatment (two weeks after steroid tapered down to twice a day) my floater increased and the A&E doctor said it flared up and asked me to increase the steroid back to once every two hours. I was seen by the consultant a week later, but he said there was no flare up although he could see the floater increased but that's normal detachment.

I mentioned more than once that the area around my eyes are sore, cheek bone, eye brow and occasionally shooting pain, but no one gave me a reason for that -- one doctor said that's because I have been pulling my eye lid to apply the steroid!

Anyway, I found this thread, and I found Mike mentioned about the relationship between herpes zoster virus (shingles virus) and the pain around the eye. Then I remember I had "waist pain" nearly the same time when I had floaters in my eye.

I got chicken pox when I was little and had a very bad shingles when I was about 20yrs old. At beginning of last year, I had 2-3 weeks "skin pain" around my waist followed by some blisters afterwards. They went away in another 2 weeks without any treatment. This summer I had a similar pain around my waist although no blister appeared. But now I am wondering whether it's shingles again and the possible cause of uveitis?

However, would the virus cause intermediate uveitis or just anterior? As my inflammation seems mainly in the middle part of eyes - started with 2+ vitreous inflammation and snowball (I don't know what that mean though) when the eye doctor first saw me.

My second question is would the reduced level of neutrophil and WBC a resulte of herpes zoster virus infection? It has been 2.5 month now since it first diagnosed, are the IgM and IgG test for herpes zoster virus still meaningful?

My third question, the floaters doesn't seem to settle down (after suspected flared up), unlike when it's first started 2.5 month ago which improved three days after the steroid. Are they normal floaters? or are they caused by the virus?

Finally, shall I take Acyclovir to see how it goes? Would it help with the floaters or pain or both?

Many thanks for reading my lengthy post although I try to make it as brief as possible.

I look forward for your reply, thanks!