Iritis, an introduction

Issues concerning developments in care of Ocular Inflammatory Disease and other noteworthy Items are contained in this forum.

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Mike Bartolatz
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Iritis, an introduction

Post by Mike Bartolatz » Sun Jul 31, 2005 5:17 pm

Iritis is inflammation predominantly located in the iris of the eye. Inflammation in the iris is more correctly classified as anterior uveitis. the ciliary body can also be inflammed and this would then be called iridocyclitis. Uveitis is inflammation of the Uveal tract within the eye which is divided into three segments, the iris and ciliary body comprise the anterior chamber. the intermediate portion of the eye is comprised of part of the cilary body called the Pars Plana located just behind the iris as well as the front part of the Vitreous humor where inflammatory cells appear as floaters and protein called flare. the back of the eye also has the uveal tract located under the choroid; when this is inflammed it is called posterior uveitis. if all three parts of the eye become inflammed one then has Pan uveitis.

When the iris is inflammed, white blood cells (leukocytes) are shed into the anterior chamber of the eye where they can be observed on slit lamp examination floating in the convection currents of the aqueous humor. These cells can be counted and form the basis for rating the degree of inflammation. this is measured on a scale of 1-4, four being one heck of allot of cells (this is further explained in the Glossary of medical terms at http://www.uveitis.org.) these cells can accumulate and cause adhesion between the iris and the lens.

initial treatment of iritis which is not caused by a pathogen (virus, bacteria, mycobacteria, ureaplasma, yeast, mold or fungus) is through the use of topical corticosteroids. if adhesion is anticipated then a dilating drop is used to relax the ciliary body preventing the iris from adhering to the lens in a closed position. Iritis that is stubborn, recurrent or chronic may require systemic treatment through the use of oral steroids, or other immunomodulating drugs. Some individuals will have genetic predisposition to uveitis which is related to autoimmune disease processes. the most common of these 'genes' is the HLA B27 Haplotype which can predispose to uveitis alone or to the Seronegative Spondyloarthropathies and the enteropathic arthropathies. examples are Ankylosing spondylitis, Reactive arthritis (Reiters syndrome), psoriatic Arthritis, irritable Bowel disease and Crohn's disease. Recently the IL23RN, IL1RN and ARTS1 genes have been found to be related to ankylosing spondlyitis, Psoriasis, Chron's disease and Systemic Lupus Erythematososis, Hashimoto's thyroiditis, psoriasis and psoriatic arthritis and possibly Multiple sclerosis and Behcet's diseases. there are other autoimmune disease processes also related to iritis/uveitis: Multiple Sclerosis (HLA B15), Sarcoidosis, systemic Lupus Erythematosus, Lyme disease, Juvenile Ideopathic Arthritis, and Behcet's disease are examples as well as the Mixed Connective tissue Diseases. Sexually transmitted disease processes, syphilis, gonorrhea, HIV, Chlamydia T can also be related to uveitis as can Cat Scratch disease, Toxoplasmosis, toxocardia, Presumed Ocular Histoplasmosis syndrome, Lyme disease, whipples disease, valley fever, Tuberculosis, leptospirosis, Rocky Mountain Spotted fever , west nile virus and others. Salmonella poisoning can trigger HLA B27 related Reactive arthritis as well as uveitis in some individuals

Because of the relationship between Uveitis and over 90 different pathogens and autoimmune disease processes we suggest that individuals with recurrent or chronic uveitis be treated by an Uveitis specialist or Ocular Immunologist. One may have to travel to see one of these very rare specialsts but by doing so, the health of the patient as well as long term positive outcomes for the uveitic eye will occur. some of these consequences to lack of treatment or under treatment are: epiretinal membrane formation, cystoid Macular edema, cataracts, Glaucoma, detached retina, Vitreous hemorrhage, and vascularization of the retina.

uveitis is the third leading causs of preventable blindness in the developed World. Most opthalmologists are not trained in the diagnosis and treament of difficult to control uveitis. A list of specialists has been developed by C Stephen Foster MD of the Ocular Immunology and Uveitis Foundation here in the USA. One can access this list by going to http://www.uveitis.org once there visit the PATIENT information Section of the site.

I've just rebuilt http://www.parsplanitisforum.yuku.com which has an extensive database on Uveitis, its relationship to diseases , pathogens , Cancers as well as other Ocular Inflammatory diseases. I suggest that you visit the site for the latest information on diagnosis and treatment.

Our general discussion forum and other forums available here are an excellent way to ask questions and read up on various medical conditions related to uveitis. Feel free to join in the discussion when you feel comfortable with us.




wish all the very best!

mike
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Mike McPartlin
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Blurred Vision Following Iritis Attack

Post by Mike McPartlin » Tue Aug 23, 2005 7:15 am

Hi Mike, Thanks for this site which I have just discovered. Sadly I am not new to Iritis and have suffered attacks approx every 5 years since I was 17 (1970).
I have just recovered from my latest attack and am now at the stage of stepping down the steriod drops (Vistamethasone / Betamethasone drops). I am currently on 4 times a day and will go down to 3 next week etc.
Although I came off the dilating drops over a week ago my former (farly clear) vision in my left eye has not returned and is still almost as blurred as when I was on those drops. Do you know if this is possible and whether this could be permanent? This attack was not particularly ferocious and I caught it before it got very painful or inflamed. I got my eyes tested on Sunday just to see what's going on, and my optician tells me that my vision has deteriorated at an unnaturally high speed in my left eye. I know by the feel that this has all happened since my infection started 4 weeks ago.
I hope you can advise.
I intend to contribute more on my previous experiences during my 35 years as a sufferer of Iritis.
Mike McPartlin

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

specialist in Scotland

Post by Mike Bartolatz » Tue Aug 23, 2005 11:52 am

First of all welcome to the group.
there is a specialist in Scotland that I recommend you see. he is listed under UK specialists if I recall correctly. many things can happen quickly with uveitis like Cystoid Macular Oedema for example that must be tested for when unexplained loss of vision occurs quickly or even elevated intra ocular Pressure.
you can find contact information at http://www.uveitis.org under Patient information.

it can take several weeks before vision returns to normal once you are off all eye drops.
you could also have allot of protein (flare) causing distortion of visioin too.

wish you the best,
mike Bartolatz
Mike Bartolatz
Moderator

IPfan

Newly Diagnosed

Post by IPfan » Tue Aug 23, 2005 6:29 pm

Hi Mike,
I just experienced my first case of iritis.....the symptoms started on Sunday, and luckily I work for an occuloplastic surgeon who is also an ophthalmologist (not practicing). He put me on steroid drops as well as dilating drops and now my pain is gone as well as some of the redness. My vision is cloudy in that eye. My question is: How long does a person normally stay on the eye drops once the symptoms have gone? Thanks for this site...it's great!!! Debi

Mike Bartolatz
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Welcome Debi

Post by Mike Bartolatz » Wed Aug 24, 2005 12:59 am

it usually takes about three weeks or so for your eye to clear up and the drugs to get out of your system.
hopefully this will be your case and it will NEVER RETURN. that is my wish for you.
if it returns, we are here to get you to EXPERT care which is available throughout the World now but you may have to travel to see one of these mostly University Medical School specialists known as Ocular Immunologists.. if it keeps coming back you need to look into a steroid sparing approach to treatment to prevent consequences of steroid use as well as chronic or recurrent uveitis. I know you work for a surgeon and they think a knife is the way to go but surgery in a uveitis patient is not well tolerated. only about 85% of cataract surgeries are successful with IOL explantation required because of the inflammatory response. the same is true of glaucoma surgery. Of course the expertise of the surgeon is of paramount importance with allot of experience in Uveitis patients helping lead to success.

Wish you the very best,
Mike Bartolatz
mike@parsplanitis.org
Mike Bartolatz
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Murali

Iritis

Post by Murali » Sat Nov 19, 2005 6:09 am

Hi Mike,

I have this Iritis problem recurring more or less once in two years... In the last 10 years I have got it for about six times (4 times on my right eye and twice on the left eye). Everytime the medication will be steroid. Apparently the root cause of this recurring problem is due to Ankylosing Spondylitis (AS). While I am taking treatment for that for the past couple of years, I still get this Iritis problem.

Can you please let me know whether treatment for AS will eventually help me from not getting affected by Iritis again.... Also, would frequent Iritis problem result in losing vision? If so, after how many times? Is there any data available based on some research or case study?

Thanks,
K.Murali

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

iritis

Post by Mike Bartolatz » Sat Nov 19, 2005 11:11 am

suggest you go to http://www.uveitis.org and read about HLA B27 related uveitis and the modern treatment of both uveitis and ankylosing spondylitis and the genetic disease processes associated with HLA B27.
your uveitis will be a lifelong problem unless other drugs besides corticosteroids are used to top it from re occuring. it is impossible to say how fast your uveitis will progress to loss of vision but it will in time from the inflammatory process as well as from the use of corticosteroids to treat it. after about 850 drops of 1% prednisilone acetatete, cataracts develop. this is a cumulative process which is not reversible. oral and injectible steroid add to this as well as present other problems for the eye and body.

wish you the best,
mike

PS: start reading at this site in various forms and you will learn allot about this topic
Mike Bartolatz
Moderator

Lisa Miller

Look for more information

Post by Lisa Miller » Thu Dec 22, 2005 7:28 pm

I was just diagnosed with iritis. This is my first experience and I am very confused as to what can cause this condition. I just went for a blood test, to be tested for several of the diseases listed on this site. This is really scary, all the things that I am being tested for. I am a very healthy person and have no other issues.

I have a real concern, my current doctor has prescribed Prednisolone Acetate Ophthalmic Suspension, which I have been instructed to place 1 drop in my every 30 minutes while awake. Needless to say this is very challenging, due to my lack of clock watching, it is more like I place in one drop every hour to two hours. The doctor wants me to continue this application for another whole week. There has to be a better way and something that I can actually take or drop in my eye in a more realistic time schedule. I am having a small side effect from the drops, only in a dark room it is like someone has pulled a shade over my right eye. It is very strange, my vision with my glass has not been affected, my only current discomfort is only be able to see out of one eye in a dark room. Can you make any recommendations as to where I learn more on your site or others. Thank you in advance for your time and consideration.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Welcome

Post by Mike Bartolatz » Thu Dec 22, 2005 10:43 pm

We have allot of information available for you to read through in sticky notes here at the general discussion forum as well as in other links to information, the best way to start off learning about iritis is to go and read through the glossary of medical terms used by opthalmologists. it is a relatively easy to understand glossary with links to treatment and causes of iritis and other forms of uveitis. http://www.uveitis.org go to the patient information section and click on GLOSSARY to the left side of the screen,

I hope this helps,
mike
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alicia71
Posts: 1
Joined: Wed Jan 11, 2006 10:04 am

Newbie here

Post by alicia71 » Wed Jan 11, 2006 10:11 am

Hi my name is Alicia and I am also a 5th year sufferer of Iritis. This is my 4th and longest bout with Iritis. I am currently taking Pred-Forte and Atropine drops. They started me on the Forte every 30 mins. and now am at every 2 hours for the past 3 weeks. My vision does not seem to be improving although the pain seems to be only in the evenings once my eyes are too tired too see any longer. My Dr. does not want to do the injection as my preivois Dr. always did. He says it should be used only as a last resort. They have not been able to find the cause which they are very suprised with givin the severity and my age. I am curious to know if anyone has had permanent vision loss and if there are treatments avilable for such loss????

Thank you,

Alicia
Regards,
Alicia

Mike Bartolatz
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Post by Mike Bartolatz » Wed Jan 11, 2006 10:33 am

yes permanent vision loss can occur due to complications of the inflammatory process. damage occurs over time with this. one can become a steroid responder, an individual who's intra ocular pressure goes up while on steroids. this can damage the optic nerve as well as areas of the macula causing loss of vision. the debris can also accumulate and block the duct that drains the eye of fluid. this too can increase pressure in the eye.
cataracts can also develop from both the steroids as well as the disease process. other complications such as epiretinal membranes and cystoid macular edema can develop which can lead to retinal tear or detachment. this is why we suggest that one get an ocular immunologist or uveitis specialist involved in care. they treat inflammatory eye disease for a living with extensive training in the diagnosis and treatment of uveitis. a steroid sparing approach to treatment is advised in most instances. a stepladder approach to treatment is also advised. trying NSAIDS such as Indomethacin SR, Voltaren, Naprosyn or Celebrex is often the next 'step' in this approach to try to quell the inflammation in autoimmune related uveitis. in severe cases that don't respond to steroids or recurr or are chronic it is suggested that immunomodulation be employed once all causes are ruled out such as pathogens like viruses, Bacteria, protazoan, mycobacteria or sexually transmitted disease processes. there are about 85 directly linked causes of uveitis so one must do a complete medical exam as well as to look to familial autoimmune disease and exposure to pathogens both at home, work and while on vacation within various areas of the World.
we have a specialist list that you can look through as well as allot of information on related conditions in various forums here at this site. we also link to other websites for information and support. I suggest that you go to http://www.uveitis.org and read about this in the Patient information section of the site. there is an excellent GLOSSARY of medical terms used by opthalmologists to describe this stuff. Learn all you can so that you can become your own best advocate as no one will do it for you. there is also a fantastic support group affiliated with that site at http://www.uosg.org

I hope this helps,
Mike
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V. Brazeau

New to Iritis

Post by V. Brazeau » Tue Feb 07, 2006 9:36 am

I just finished weaning off the eye drops and my eye is back to normal again after being a first time sufferer of Iritis. My eye started off turning red without me feeling anything. After a few days, I started getting very sensitive to light. I went to a medical doctor and they were trying to prescribe me Garisone and Visine for allergy eyes. I had a gut feeling not to fill that prescription, because my eye wasn't itchy or crusty...it felt like a muscle pulling when I would look around. I went to the optometrist's office for the heck of it and told them that I cannot go another day without some kind of pain reliever and I told him that I was not going to fill my prescription until I know what's really wrong with my eye. He fit me into his busy schedule that day and told me my gut feeling was right because I have Iritis and I need two different types of drops. That was two months ago and now he said my eye looks good and let's HOPE it doesn't come back, but I know it could and I've accepted that.
Is there any other ailments that I should be tested for? Is there some type of link to Iritis and the rest of the body? I have a family member suffering terribly from Rheumatoid Artritis; does he run a risk of getting Iritis or any other eye disease?

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Tue Feb 07, 2006 11:18 am

we have allot of information on the links between autoimmune disease and pathogens related to iritis/anterior uveitis.
usually testing isn't done until one has recurrent or very difficult to control uveitis. your relatives likelyhood of developing uveitis is the same as the general population at about 11 per 100,000. Scleritis does occur more often in RA patients. other autoimmune disease processes like Sjogren's syndrome and Lupus occur frequently in conjunction with RA.

wish you the best,
Mike
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Anne

Oh not again!

Post by Anne » Wed Apr 05, 2006 4:37 am

Having had about three bouts of iritis connected to ankylosing spondilitis. I am in the throws of feeling another one coming on. Is the best course of action pain killers until the eye becomes visibly effected, or should I contact the hospital with just pain around the eye area? I always hope it might just be a prolonged headache.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Wed Apr 05, 2006 9:45 am

you should always get your opthalmologist involved early on with anything concerning the eye. even if it isn't a new bout of uveitis it could be posterior scleritis for example and that is treated a bit differently than uveitis.
ask about NSAID therapy with your confirmed link to ankylosing spondylitis. Indomethacin SR, Voltaren, Naprosyn or Celebrex are the ones ofteh used here in the USA. a six month trial might do the trick but you might have to try more than one before your figure out which will work best for you.

Wish you the best,
Mike
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