Progressive nature of Uveitis?

[Mary Ann]

I've had Iritis for 25 years - part of Reiters Dx / HLAB27+. It's been over 4-5 years since I've had a major flare up which have been classic, red, light sensitive and painful eyesocket pain. At times chronic but my vision always returned to normal afterwards. In January 2012 I had a case that felt different from the start. My head (scalp) hurt and the MD said it was posterior uveitis. I am unsure if I've had posterior before but I think it was mainly anterior. The MD did say that posterior uveitis reflects a more systemic issue going on. We changed the drops and though overall the classic symptoms have improved I have developed black speckled floaters, bright flashes in the peripheral of my vision and for quite awhile I was seeing what seemed like a film of bubbles in the vision of the impacted eye. The doctor has looked and stated no retinal tear. But I am not seeing a retinal specialist but someone who is reported to know about iritis. Now on top of this I had an appointment with a dermatologist last week who identified a shiny bump over the impacted eye and took a biopsy due to looking suspicious. I remembered sensing a pain similar to a boil but in my 2 sec of looking at it, there was no discoloration and I ignored it. I wonder if there is any relationship to all of this. Or is this just the Iritis progressing? Any thoughts??

[Mike Bartolatz]

it sounds like you need to go beyond steroid eyedrops for treatment and this should have been done years ago now that you have posterior changes from long term smoldering uveitis. you description of lots of floaters might indicate that you now have exudate along the pars plana from intermediate uveitis or cells shed from the posterior segment causing vitritis.
did he do an OCT scan, optical coherence tomography to look for Cystoid macular edema or order a fluorescein angiogram (dye injected into your arm and then photographs taken at various intervals to look for leakage from blood vessels)?
sometimes the vitreous membrane that separates your vitreous jelly and the retina begins to tug resulting in traction on the rods and cones resulting in flashes of light. the vitreous can detach and cause bleeding or even detachment of the retina.

please tell me where you live so that I can suggest a visit to an Ocular Immunologist so that MODERN steroid sparing approach to treatment can prevent further changes inside the eye that can rob you of vision. I do my support work so that others won't end up like me from a steroid only approach that often leads to blindness. I have lost signficant vision and it doesn't have to happen to you.

Wishing you the very best,
mike

[Mary Ann]

Hi Mike. Thank you for all your information and willingness to continue supporting others. These recent changes have been a real wake up call - very scarey . I appreciate your ability to connect me with a practitioner. I live in Joshua Tree, CA. I am willing to travel as I am most likely have to because JT is rural. My current ophthalmologist is in Rancho Mirage (zip 92262) . Maybe Loma Linda University ? Thanks again. Mary Ann

[Mary Ann]

The only type of examinations that have been done are the most basic. This includes the slit lamp (?name) and the doctor viewing the dilated eye in his /her office. Thanks. Mary Ann

[Mike Bartolatz]

the doctors that I would see in California are Dr Rao at Dohenney Eye institute, DR Levinson at UCLA and DR Ira Wong in Sanfranciso. their contact information can be found at http://www.uveitis.org on the Specialist list in the PATIENT information section of the site.

I hope this helps,
mike

[Mike Bartolatz]

Did you ever have a bout of VAlley Fever? this can cause uveitis and is found in the Desert areas of California and the Southwestern States.

mike

[Mary Ann]

Hi Mike, I have not had Valley Fever. My HLAB27+ status was identified after my first case of iritis which was 5 months upon returning from China in the mid 80's. 2 days before returning from my trip I got severely ill with a GI bug. Within weeks of returning, I had severe back pain. I didn't seek medical care until I had the irits 5 months after returning. It was thought at that time that the GI bug in China sparked my HLA and associated symptoms, back pain and iritis. The rheumatologist dx me w/ reiters syndrome at that time. It appears that much more is known now than in the 80's. And it looks as though they have renamed my form of HLA dx as Reactive Arthritis...? I do have some of my old reports and in first review it looks like my first bouts were anterior chamber iritis. I think this is my first posterior iritis and for sure the first time that I've had floaters and flashes. I will follow up with one of the MD's you referred to above. Thanks. mak

[Mike Bartolatz]

With posterior uveitis, see DR Rao as he is a retina specialist and ocular immunologist. I have had good feedback from others with posterior uveitis and HLA B27.
reiter's would have balanitis associated with it with genital sore and perhaps on you legs. achilles teninitis would be present as well as mouth sores. the pathogen that sets off HLA B27 problems can have a mixture of symptoms of any of the sero neg spondyloarthropathies and the GI stuff with Crohn's and ulcertative colitis. some only get uveitis but it is still triggered by either a GI bug or a Sexually transmitted one as is the case with Reiter's/reactive arthritis. the main thing is to suppress the immune system with appropriate medications and then go on a 2 year protocol to stop the immune response in your eyes.

HLA B27 uveitis often succumbs to NSAID therapy through use of Celebrex, dolobid or Naproxen at prescription strength for TWO YEARS but it can take a few months to know if it will work. if you flare up on it, then you must move on to a DMARD alone or in combination with a TNF A blocking drug such as Remicade or Humira.

I hope this helps,
Mike

[Mary Ann]

Thanks Mike. You are a wealth of information. I am trying to coordinate the MD appointment for the near future. All this information is helpful. I would also be interested in working with a rheumatologist. Do you have any recommendations? Thanks in advance.

[Mike Bartolatz]

no I don't have any recommendations. If you see Dr Rao or Levinson, ask whom do they work with at the University. Thats about the best I can tell you as there isn't any safe way to pick a doctor. the only thing I can think of is 'angie's list' on the web where people give doctors reviews. the thing about that is it is either over rosey or over negative. everyone thinks they have the 'best' and that just isn't the case if you know what I mean.

take care,
mike