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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Post by Mike Bartolatz » Wed Jul 09, 2008 12:41 am

welcome to the group!
there are a couple of doctors in Arizona but I don't know if they are fellowship level trained ocular immunologists or uveitis specialists.

HLA B27 related uveitis can be very difficult to control with it ping ponging between eyes. no arthritic disease can be the case so not much need for additonal 'diagnosis' other than that it is most often iritis and cyclitis which inflammation of the iris and ciliary body which produced the fluid inside the eye as one function. this is referred to as iridocyclitis. if allowed to smolder or to only use coritcosteroids and dilating drops, damage over time to tissues inside the eye can occur resulting in things such as cataracts, glaucoma, cystoid macular edema, etc.

if you would ask this question in a new topic in this forum others from your State can easily respond. I put one name and contact information recommended by our members and I also put the name of a lady who is at the University medical school there in arizona as well. these are invarious threads in the SPECIALIST forum,
the closest true ocular immunologists are in LA and Salt Lake City that I am aware of: Narsing A Rao in LA at Doheney eye and dr Levinson there in LA as well. Dr Albert Vitale is in salt Lake city. contact information for these specialists can be found there as well.

I hope this helps.
Mike
Mike Bartolatz
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Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Wed Jul 09, 2008 12:54 am

http://www.iritis.org/forum/search.php?mode=results
above you will find a link which contains posts that had Arizona in them. a doctor in Tucson has a support group and there is a highly trained doctor at the Medical university contained in a thread too.

I hope this helps,
Mike
Mike Bartolatz
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jaymcentee
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Joined: Tue Jul 22, 2008 10:13 am

1st iritis case - fairly remote Tanzania

Post by jaymcentee » Tue Jul 22, 2008 10:29 am

Hi,
Thanks Mike for this site and forum. I am suffering iritis for the first time (28 years old), and unfortunately I am in a place where it's difficult to find a second opinion on what I might do. I had pain in my left eye about 10 days ago, followed by a few days without pain, and then pain again. I drove approximately 3 hours on the last day before I started having vision loss. I had lots of pain accompanying the vision loss initially. I was fortunate to see a few American opthalmologists in a place called Ilula, Tanzania. They have since left Tanzania, and I have consulted twice since then with a local optometrist. The American opthalmologists prescribed Mydral dilating drops, 2x/day for a few days until the pain went away, and prednisolone acetate opthalmic suspension 4-6x/day for 2-3 weeks, tapered off afterwards.
The Mydral has worked well for pain, but I am now on my 6th day of using it, and if I don't use it the pain returns. During the course of the 6 days of treatment, my sight has steadily become worse - extremely cloudy. Today, I could read only the top two lines on the eye chart, and it may have become worse over the course of the day. The result of the eye exam was written 6/36 here. The Mydral no longer causes dilation of the iris, which the optometrist here said was a result of the inflammatory process. The iris continues to be very small. Pain is not bad when using Mydral, which I have been supplementing with ibuprofen.
In addition to the flat-out frustration I am experiencing right now, I am worried about my vision, and do not know what is "normal" for expectations with sight. I have been diagnosed previously with Irritable Bowel Syndrome, which has not been acting up during the iritis, but I suppose I could be an autoimmune case. Any help with regards to what I might expect for sight would be much appreciated.
My other information request regards any knowledge out there of treatment I might receive in East Africa. Maybe a long shot.
Thanks very much for reading,
Jay

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

Post by Mike Bartolatz » Tue Jul 29, 2008 10:04 am

Jay,
sorry I missed your post and so I am belatedly responding to you questions.
you need to see a Gastro enterologist to see if you have ulcerative colitis or Crohn's disease. you should be tested for the gene, HLA B27 to see if this could be related to your uveitis and GI complaints. often DMARD drugs are required to stop the progression of GI problems and Uveitis. usually one has iridocyclitis which is inflammation of the iris and ciliary body with irritable bowel disease and uveitis. sometimes the newer biological drugs such as Humira or Remicade are used here in the USA and the UK to stop both the GI tract disease and the uveitis in a corticosteroid sparing approach to treatment, the Ibuprofen might help with control of inflammation but it might also exacerbate your GI problems. specialists can help you determine what to use to help stop the inflammation. Celebrex which is a cox i and Cox II inhibitor might be a better choice of NSAID to use as a steroid sparing approach to treatment. often the inflammation will ping pong between eyes too.

Please join in our general Discussion forum.

Wishing you the best and sorry for missing your post.

Mike Bartolatz
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Rochelle
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Post by Rochelle » Fri Oct 03, 2008 3:38 pm

I'm taking MXT once a week, 10 pills each dose. (originally @ 6). I've had iritis in both eyes now for 2 years. I originally had iritis in one eye. Within 4 months I had in both eyes. The Rheumatologist did not suggest taking folic acid with the dosage. Should I suggest it to him? I have not suffered any side effects, so is it necessary?

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

Post by Mike Bartolatz » Sat Oct 04, 2008 9:36 am

MTX depletes iron from the blood stream and can cause anemia because of this. it is usually given at 2.5 on the next day after taking the MTX. if your blood tests show normal amounts of iron you may not need it. I would discuss this with the doctors however. it would help with being tired but it can increase nausea.

Wish you the best,
Mike
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Gary H
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Joined: Mon Feb 02, 2009 6:23 pm

Re: Iritis, an introduction

Post by Gary H » Mon Feb 02, 2009 6:38 pm

Hi Mike,

My first episode with iritis was approximately 12 years ago, and it landed me in the emergency room with incredible pain. Since then, it seems to visit me every 2-3 years; infrequently enough that I almost don't recognize the symptoms at first. I am currently on day 10 with my most recent episode, and my opthalmologist tells me it's a 1+. I have a family history of parents/grandparents/aunts/uncles diagnosed with diabetes, arthritis, glaucoma, cataracts, and macular degeneration. My opthamologist tells me because my iritis surfaces in a single eye and not both eyes at the same time, it's a strong indication that my issue is non-systemic. He assures me that the intervals between episodes are the "good news," meaning that it could be worse and closer episodes would cause greater alarm. Unlike my relatives, I manage my weight and exercise regularly. I lead a fairly healthy lifestyle, and other than degenerative disk disease, I have not been diagnosed with anything "serious." Is there cause for concern? Should I just continue on my path of keeping drops on standby in case iritis flares up? Or should I be actively pursuing knowledge of the cause of this problem? I don't even think about it until it flares up ... then it obviously consumes my life for 2-3 weeks until it clears. Advice?

Mike Bartolatz
Posts: 6595
Joined: Fri Feb 06, 2004 9:58 pm

Re: Iritis, an introduction

Post by Mike Bartolatz » Tue Feb 03, 2009 8:37 am

have you ever been tested for any of the causes of uveitis? did you have a sinus infection or a bout of GI stuff before this current bout that might trigger new inflammation? what type of diabetes runs in your family? if type 1 this is drirectly linked to uveitis. I know of no link between type II diabetes and uveitis (I have type II by the way). I also have degenerative disc disease but there is no connection between this and uveitis either. Ankylosing spondyitis, psoriatic arthritis, Reactive arthritis and Irritable bowel diseases are linked to uveitis. osteoarthritis is wear and tear as in Degenerative disc disease. arthritis of the hands can be related to Rheumatoid arthritis and Sarcoidosis.
what type of arthritis runs in your family?
I'm not a doctor so all I can do is try to indicate what some options might be. for you it sounds like until the bouts become more frequent or chronic there isn't much else required but once again, I'm not a doctor.

it might be prudent to do some initial testing for a baseline to see if things change between bouts.

I hope your current bout reacts quickly to the steroids and stays away for several years for you.
if it comes back right away, then I would suggest a consultation with an Ocular Immunologist. see list of specialists at http://www.uveitis.org in the PATIENT information section of the site or tell me where you live and I will suggest one of these rare specialists for you.

wish you the very best,
Mike
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