re-occurence

[kristihart]

I was diagnosed in early October 2014. It was particularly severe, and took a few months to get better. I finally was steroid free for about a month, and then all of a sudden, my eye was red next to my Iris and I had that same pain. I went to the eye doctor and they didn't see any white blood cells. The doctor did tell me to start on the steroid drops again. The next day it didn't hurt too much, and over the next few days, the redness subsided. Now today, both the pain and redness is evident. I'm supposed to go back for a recheck tomorrow, but may not make it because of family conflict with appointment time. I was just wondering if it would be common for symptoms to subside a little and then re-appear? Thank you in advance for any and all help!

[Mike Bartolatz]

yes symptoms can reoccur as you describe, are you using a dilating drop along with the corticosteroids to prevent adhesion between the iris and the lens? this additional drop also helps to relax the iris and the pain should go down. is your iritis in only one eye? do you have a history of cold sores?

does anyone in your family have an inflammatory disease or systemic autoimmune disease present such as arthritis, skin rashes, GI problems, thyroid disease?

If you are using generic steroid eyedrops, make sure you shake the bottle for at least three minutes to get the steroid into solution. then put in the drop and press in over the inside corner of the eye to prevent the drop from going down your sinuses and into your throat. this makes sure the steroid is absorbed by the eye and surrounding tissue. you will get better results if you do this. also wait about 15 minute before putting in the dilating drop.

keep your appointment with the ophthalmologist.

hope this helps,
Mike

[kristihart]

Yes, when I saw the doctor Monday, she said to do the dilating drops as well. I'm using brand name steroid drops, Durezol, 4 times a day. I do shake it up, but not for 3 minutes. I'll try to remember to shake it longer!

My eye pain has worsened the last few days and I've had some nausea. I called the Ophthalmologist today and they had me come in. They said that it actually looks better than it did on Monday, and they don't know why I'd be feeling nausea, maybe because of steroids. I tried to go back to work and decided to go home after another hour because it was so bad. I ended up losing my lunch on the way home. I've had migraines before and I'm thinking the nausea is coming from the head/eye pain.

I don't have a history of cold sores, but I do get canker sores. They already checked for Sjogren's syndrome. Now a blood test is ordered to check for about 6 different things; the gene that is associated with anklyosing spondylitis, and rf (rheumatoid arthritis on my mom's side of the family), and I can't think of the rest right now. They have also referred me to a rheumatologist and ordered a chest x-ray. I think they're checking for the lung condition you mentioned when you replied to my introduction.I do have a history of lower back pain. I was diagnosed with mild scoliosis in elementary school, so just thought that was the main reason for back problems. However, I do think it is arthritis related because it does feel better with exercise, sitting too long aggravates it, and it is worse in the mornings.

It is only one eye with iritis now and previously.

Thank you for all of your help!

[Mike Bartolatz]

What was the pressure inside your eye when you had your appointment? Durezol is usually only used for two weeks because it easily increases pressure inside the eye resulting in Glaucoma. in extreme cases severe nausea with vomiting occurs. get in for another pressure check as switching to Pred forte might be a better choice with less chance of pressure increase.
iritis that doesn't respond well to steroid eyedrops, getting it quieted down without immediately returning and only in one eye is sometimes linked to the herpes family of viruses.

this is sometimes the case with HLA B27 uveitis but it usually ping pongs between eyes. the first eye quiets down and then the other eye flares up. this cycle repeats over and over again.

GI tract disease is also linked to the HLA B27 gene. it is linked to Ankylosing spondylitis, psoriasis, crohn's disease and ulcerative colitis. you can have a mix of symptoms with this gene and also have uveitis. another gene is the IL23R gene also found in all of them and also in Sarcoidosis and Systemic Lupus Erythematosus. I assume you have severe dry eyes if they tested you for Sjogren's syndrome. all of these things can have dry eyes associated with them but Sarcoidosis causing dry eyes is through a different mechanism, a different type of inflammation that requires methotrexate to treat. Methotrexate is also used in all of the above conditions and with uveitis in a corticosteroid sparing approach to treatment.

let me know what the pressure is,

mike

[kristihart]

I went back to the eye doctor today and the pressure was 16. She has referred me to the specialist in Chicago because it isn't getting better as quickly as she'd like. There is some improvement from last Monday, but not enough.

I don't have dry eye, so the testing for Sjogren's seems like it was unnecessary.

[Mike Bartolatz]

Let me know what the Specialist says.

my best,
Mike

[kristihart]

The doctor's office left a voicemail today, they want me to use Durezol 6 times a day. I'm feeling reluctant because I believe that it caused my headache/nausea last week. Has anyone else had similar issues with this medication? Is it safe to use that many times per day?

[Mike Bartolatz]

I don't know,

mike

[kristihart]

Thanks! I'm giving it a go.

[kristihart]

The specialist said it looked better, just some pigmented cells. I am starting to taper off the Durezol and quit using the dilating drops. I have to follow-up in two weeks either with him or my local doctor. I think the local doctor since it doesn't require so much time off work. I felt better but had no way of knowing for sure that it was better. If I had known, I wouldn't have gone all the way to Chicago. I did like the specialist though. He said it will come back, do not travel without drops. He also said that in many cases, they never know why a person gets Iritis.

[Mike Bartolatz]

why the pigmented cells? is your iris shedding cells? do you have holes in the iris?

wish you the best,
Mike

[kristihart]

I do have a small part of my iris stuck to my lens from the first episode, could that be the pigmented cells he was referring to? I just heard him saying it to the resident as he was looking into my eye, he didn't say it to me. I didn't ask any questions about it. Now you've got me wondering!

[Mike Bartolatz]

pigmented cells are given off by the iris. the adhesion is caused by white blood cells from inflammation.

are you on a dilating drop to try to break the adhesion? I assume you have a misshapen iris from this.

wish you the best,
Mike

[kristihart]

The adhesion was from my previous and initial bout of Iritis, once that cleared up, there was some residue left on the lens from my iris. I was on the dilating drops until I saw the specialist last month. It was getting better, so he said that I could stop the dilating drops.

I did just come from my family doctor, because I have sinus/lung infection. They pulled my lab work and chest x-ray from last month (I haven't been back to my eye dr. since that was done) and it says positive for HLA-B27. I don't think that necessarily means I have ankylosing spondylitis, but it's a good possibility?

[Mike Bartolatz]

the things associated with HLA B27 related uveitis are ankylosing spondylitis, reactive arthritis, psoriasis/psoriatic arthritis, Crohn's disease and ulcerative colitis. HLA B27 related uveitis goes back and forth between eyes. rarely dose inflammation occur in both eyes simultaneously. it is most often iritis but it can also occur as intermediate and posterior uveitis. changes to the retina from long standing inflammation can occur as well. often there is severe dry eyes associated with HLA B27 uveitis. this is treated with the drug RESTASIS. lung involvement can occur when the underlying disease is Crohn's disease. you can have a combination of the various forms of arthritis and GI issues together in HLA B27 Disease. overlap in symptoms is common.

if you continue to have sinus and lung issues, you may wish to have a pulmonologist involved. rarely one can have Sarcoidosis and the above conditions at the same time. usually linked to the IL23R gene mentioned in my other responses to you. sinus issues can stand alone and still be sarcoidosis so an ENT visit may also be in the cards. hearing can also be impacted by this.

if there are NO symptoms of arthritis or any other symptoms for that matter, you MAY NEVER get a listed disease going on. just know symptoms for them and if you have them discuss them with your doctors. the SOONER you start alternative to steroid treatment with DMARD drugs, the less likely you are to have complications down the road to them.

I hope this helps,
Mike