Uveitis/Iritis Flare Encouraged by Flying?

[JessK]

I may be looking for a connection that just isn't there, but I can't help but see traces of one. As a result of my battle with uveitis/iritis, I've had cataract surgery, membranectomy and a vitrectomy in my left eye. My uveitis has been ruled as idiopathic at this point in time, so maybe I'm grasping at straws to find some sort of common denominator to link my flares. One common denominator is that I've flown a few weeks prior to flares.

My first uveitis flare began in early September 2010 (although it went misdiagnosed until April 2011). I had flown two weeks before my symptoms began. After returning from my trip, I was sick and was treated with a few rounds of antibiotics. Seasonal allergies were also very high in my hometown.

My second flare showed itself in the form of iritis once again in September of 2011. I had also flown a few weeks before symptoms showed up and had once again been sick shortly after flying and took antibiotics. Seasonal allergies were again present as they always are that time of year in my area.

As you can see, there are a handful of common factors: flying, illness, antibiotics and seasonal allergies.

Now, I'm almost 95% sure that I'm having another flare, and I fear that my right eye also is affected for the first time. I see my doctor tomorrow afternoon. If this is a flare, I can rule out being sick, antibiotics and seasonal allergies as common denominators. But I did fly a few weeks ago.

My question is this: Obviously, flying isn't the cause of my uveitis/iritis. But can air travel encourage a flare?

[Mike Bartolatz]

any sickness or inflammation anywhere in your body can trigger an immune system response that can lead to renewed inflammation inside the eye. have you been tested for the HLA B27 gene? with this gene, inflammation starts in one eye, is quieted down by treatment and then it can resurface in the other eye. usually it impacts only one eye at a time but it can be bilateral too.
other autoimmune diseases present with this and are genetically predisposed.
allergies can trigger an immune response that produces IL 17 which can be found in uveitis. I don't know if you have any other systemic problems that are chronic or recurrent such as skin rashes, arthritis or Central Nervous System Involvement that could be linked. the GI tract bacterias can lead to uveitis as well as things such as TB, sexually transmitted bacteria etc.
there are many other pathogens in regions of the World that can cause this too such as Malaria, lyme disease, cat scratch disease, leptospirosis, fungi, yeasts and molds.
once you have this repeatedly, it can manifest only in the eyes as the cells can replicate over and over again and a corticosteroid sparing approach to treatment would be warranted to prevent steroid complications to the eye and in order to get to remission, you must be off steroids for about 2 years constantly using other classes of drugs to get you to 'off all steroids without inflammation.'

If I were you I would seek a consultation with a true expert in diagnosis and treatment of the underlying cause and then using appropriate medications in a steroid sparing approach to treatment. there is a list of real experts called ocular immunologists at http://www.uveitis.org in the PATIENT information section of the site. there is a USA list and an Internationale list of these specialists.

while on topical steroids and injections my eyes would bleed causing subconjunctival hemorrhages to occur on landing. steroids and nsaids can weaken the microscopic blood vessel and cause them to burst. from what I have been told, the pressure inside the cabin is at that of abut 5,000 feet and it shouldn't cause problems. I think it is linked as these were the only times that it has occurred.

flying per-say doesn't trigger uveitis. a pathogen ingested or inhaled might trigger renewed inflammation inside the eye

[JessK]

Hey Mike,

Thanks for your reply and for sharing your knowledge. The rheumatologist consulting with my doctor at Cincinnati Eye Institute tested me for the HLA B27 gene, which came back negative. They also ruled out TB, Cat Scratch, Sarcoidosis, Malaria, lyme disease, cat scratch disease, leptospirosis, fungi, yeasts, STDs and molds.

I have had another symptom present during flares of Uveitis or Iritis: fissures. My GI and CEI doc thought that there had to be a connection. Endoscopy and colonoscopy showed no signs of GI related diseases. I am heavily debating consulting a second rheumatologist just for another opinion in finding a connection.

I went to CEI today and am thankful that my right eye is still clear of any inflammation. But my affected eye, the left, is in the early stages of a flare. So I am going back on the drops.

I do think that flying and/or seasonal allergies are definitely linked somehow to my inflammations. If they are, I wonder if there are proactive actions that I can take?

Thanks for your response. It means a lot!

Jess

[Mike Bartolatz]

if this is in only one eye, do you have a history of cold sores caused by the herpes sx virus?
do you have elevated pressure in the eye? often the herpes sx virus causes a lot of adhesion between the iris and the lens which raises pressure inside the eye. inflammation returns quickly once steroids are tapered.

any chance of going to Columbus, ohio to see DR Dino Klisovic an ocular Immunologist trained by Dr Foster at Harvard for a consulation. In my lay opinion he is the best Ocular Immunologist in Ohio.

I am confused? where are the 'fissures'? in your intestines? could this be related to Crohn's disease?

other genes implicated are the iL23R and ERAP1 genes for ankylosing spondylitis, psoriatic arthritis, CROHN'S disease, breast cancer, Systemic Lupus Erythematosus and Behcet's disease.

sarcoidosis has a lot of bizarre symptoms systemically. could it be related through the NOD2 and CARD15 genes sometimes seen in sarcoidosis and Crohn's disease?

ulcerative colitis is also linked to uveitis.

contact information for Dr Klisovic can be found at http://www.uveitis.org in the PATIENT information section of the site on the SPECIALIST list.

there are no definitive tests in serum for sarcoidosis. it is confirmed by a biopsy of inflamed tissue. often from a salivary gland, lymph node, skin lesion or bone biopsy if present or nerve biopsy.

rarely micobacteria avium has been isolated in intestinal lesions as a trigger for Crohn's disease and lung involvement that mimics sarcoidosis granulomas. this was done through a protein P38 found in crohns disease biopsy a few years back. also found in lung granulomas.

seasonal allergies are sometimes confused with sarcoidosis as is asthma. sinus involvement is common as is parotid gland swelling.
wish you the best,
mike