Uvetis and Dry Eye Syndrome

[beeinformed]

Approximately five months ago, I had posted an introduction about my multiple auto-immune related eye disorders . I have Lupus and Sjogren's disorder, both of them affecting my eyes. I had mild dry eye disorder for many years and then about eighteen months ago, I started getting moderate to severe attacks of eye pain and by the fifth attack, my eyelids became severely swollen along severe eye pain, photosensitivity, redness and tearing. Since that attack, I have been to several opthomalogists, including Dr. Michael Samson, whom I am currently seeing. The doctor I saw prior to seeing Dr. Samson, gave me numbing eye drops and an eye dye to determine the severity of my dry eye disorder and approximately two hours later I developed very severe inflammation of the eyelids, along with severe pain, photosensitivity, redness and tearing. One week later, I went back to the same doctor and he determined that I had some iritis (traces of cells were seen in the eye) and severe chronic allergic conjunctivitis. After discovering Dr. Samson's name through this forum, I contacted his office and made an appointment to see him. During my initial visit with him, Dr. Samson determined that the underlying auto-immune disorders I have (e.g.Lupus and Sjogren's) had permanently destroyed about seventy to eighty percent of my tear glands He suggested that I initially try Restasis and/or Lotemax to try to reverse some of the damage done to my eyes and if these treatments did not help I could try either blood serum eyedrop treatment and/or the Boston Scleral lens ( I would have to go to Boston, Mass., where I would be fitted with special lens that would cover the sclera portion of the eye). As per Dr. Samson's suggestion, I tried the lotemax and unfortunately, although it was very soothing on the eyelids, due to the detrimental changes that were seen in the cornea and increased pressure in the eye, Dr. Samson suggested I stop taking the medication and suggested I try Restasis and see if that will help me. Unfortunately, after every opthomalogist's visit I have had since September (when given eye drops to dilate or numb the eyes), I developed moderate to severe inflammation of the eyelids along with varying degrees of pain, photosensivity, redness and tearing. As a result of this, I was very intrepid about starting the Restasis because it contains castor oil, which can cause severe burning, pain and redness in severe cases and so I have decided to try the Restasis when I know Dr. Samson will be in his office and available to help me if I develop the severe inflammation of the eyelids, pain, photosensitivity,etc. I would like to add that as far as the bouts of iritis I had in the past , Dr. Samson said that if I should develop another flareup of iritis, he would he give me prednisone eye drops.This is my update since my last post on this forum and would like to know if any of the members have experienced a concurrent dry eye disorder and uveitis. I look forward to hearing any feedback or comments from the members. Thanks.

[Mike Bartolatz]

Welcome and I recall your case presented some time ago.

as you may recall I do have severe dry eyes with punctal plugs implanted. I don't use restasis however as the punctal plugs have allowed what little tear film I produce stay on the surface of the eye and my eyelids don't stick to my eyes anymore. I do use Refresh PM gel lubricant eyedrops at bedtime and an occasional drop or preservative free Refresh Endura or Refresh plus.

the Restasis will sting terribly until the surface of the eye is healed. little by little this pain will go down until you won't feel it. it can take six months before you will notice an effect most likely so stick with it.

has your uveitis moved to the back of your eyes? has vascularization started too or Cystoid macular edema or Epiretinal membranes?

I have SICCA going on. no mouth sores but dry eyes, dry mouth to some degree as well as very dry skin.

Wish you the very best,
Mike

[eyeballs]

hi mike,

what is the difference between SICCA and sjogrens? since my rheumy suspects sjogrens, how can i tell the difference? i do not have mouth sores but i do have dry eyes, sometimes dry mouth and sometimes dry skin....

thanks!

[Mike Bartolatz]

a negative biopsy of the salivary glands would mean it isn't sjogren's syndrome. there are other symptoms needed too if you don't have serum antibodies for sjogren's at this time.

SICCA is used when there is another autoimmune disease present or if there is no other autoimmune disease present. so if you had dry eyes and ankylosing spondylitis, then it would be called SICCA. if you had AS and sjogren's, the sjogren's would be secondary to AS.

Wish you the best,
Mike

[beeinformed]

Hi Mike,

I have a question for you regarding the use of aesthetics(numbing), dilating and/or dye drops used by eye doctors during the examination for various purposes. In your experience as the moderator of this forum, have you ever heard of or read of a person who gets moderate to severe swelling of the eyelids, pain, photosensitivity, redness and/or tearing due to administering the eye drops I mentioned above. Unfortunately, since last September, 2008, every time I saw my doctor and he gave me the drops I mentioned above I would get (moderate to severe eyelid inflammation, pain, photosensitivity, redness and/or tearing) resulting in a corneal/conjunctivitis and/or iritis attack. At my last office visit, a senior opthalmalogist who was assisting Dr. Samson (my physician), told me he has never seen a patient with my symptoms before. If it is possible, I would appreciate it very if you could relay my comments to Dr. Forster. Thanks.

[eyeballs]

hi beeinformed,

are you seeing dr. ali? just wondering if he is still there... i was a patient of dr. samson for a few months before i switched to dr. foster in cambridge...

good morning.

[Mike Bartolatz]

What may be occuring is an allergic reaction to the preservative in the various drugs used. Corneal toxicity can occur with one specific type of preservative, I can't recall the name offhand so I'll look it up and post it here.
Durezol a new steroid for topical use doesn't have this preservative.
some people are allergic to the Fluorescein dye as well.

Wish you the best,
Mike

[Mike Bartolatz]

(benzalkonium chloride can cause corneal toxicity especially with long term and chronic use drops

[eyeballs]

hi mike,

can this also cause redness of the skin around the eyes? i was taken off travatan z because of a reaction and i'm wondering if maybe it was the same thing....

also looking for answers... hope your day is going well.

[Mike Bartolatz]

ASK Dr Foster. if you have rosacea that is most likely the cause of the redness.
allergic reaction can cause puffy red eyelids.
it's that time of year again so pollen and molds are in abundance here in the USA.
it would be tragic to blame a med for a normal allergy to naturally occuring substances.

Wish you the best,
Mike

[eyeballs]

hi mike,

it's hard to know what the cause of the redness was but dr. foster recommended i stop the travatan z and the redness went away almost immediately. this was months ago so i don't think it was an allergy to anything outside. it's a mystery! thanks for being out there!