My first week with iritis - tips appreciated!

[Wally]

Hi everyone,

I found this site today and have already gotten a lot of great information from the various topics here. I wanted to share my story and hopefully provide any answers for folks who have similar questions.

A bit about my situation - I'm a 24 year old living near San Francisco, California. Just this past Friday (9/28) I woke up to a completely bloodshot left eye, dull achey discomfort, tearing, blurred vision and sensitivity to light. Thankfully, I was able to visit an eye doctor that same day, was promptly diagnosed with iritis, and prescribed 1 drop of Prednisolone every 3 hours. My condition seemed to be improving until that Monday (10/1), when I woke up to some sort of flare-up in which most of my symptoms had returned. Unfortunately, I think this was mostly due to a misunderstanding on my part, since I had stopped taking my eyedrops the day before, thinking that my symptoms were almost gone anyway.

I returned to the eye doctor, who decided to bump me up to 1 drop of Prednisolone per hour. Things seemed to be turning up again, until I woke up just this morning (10/3) to another flare-up in which my eye was once again bloodshot, vision was blurry, and I was experiencing discomfort (thankfully the photophobia has never returned). I'm honestly stumped about this, because while I had been taking the drops every other hour (putting them in hourly seemed to be irritating my eye), I'd still been taking them consistently throughout the day. It leads me to question a few factors that may be causing my affected eye to become irritated and inflamed. I hope that some of you will be able to address my questions:

1. Does heat affect the onset of iritis? - Monday through Tuesday of this past week have been exceptionally hot in my area, and I wonder if this may have triggered my second flare-up, even though I had taken my last drop of medication hardly 5 hours before.

2. Does computer use affect iritis? - I had asked my eye doctor about this already, and he firmly states that being on the computer should not have an effect on my condition. Seeing that I didn't want my iritis to put a damper on my job search (and I'll admit, a bit of gaming in the evening ), I spent most of Tuesday (10/2) on the computer, and experienced my second flare up early the next morning. Should I be staying away from the computer as much as possible until my condition improves, or does it not matter?

3. Is it really that important to put in the "right" amount of drops? - I'll readily admit that due to some bad experiences in the past, I don't entirely trust doctors, and tend to put my instincts first, which I don't think is an entirely bad thing. However, I'm starting to wonder if doing the drops every other hour rather than hourly would cause my eye to flare up like it did this morning. Has anyone had a similar experience?

Unrelated to the flare-ups, I have a few general questions:

What is "corticosteroid sparing approach" to treating iritis? Is there a possibility that my vision might be affected by taking Prednisolone?

Can anyone recommend a physician in the California Bay Area who may be able to help me? I'm looking into seeing a doctor at Stanford, but want to keep my eyes open for any possibilities.

Again, thank you to the forum members for all your information and experiences. It's helped me feel a lot better. I hope that my first bout of iritis turns out to be my last, but even if it isn't, my hope is to control it as best I can.

[Mike Bartolatz]

Go to http://www.uveitis.org patient information section of the site and look through the specialist list for an Uveitis specialist in the Bay area. Ira Wong is an excellent choice.
if you are using the generic prednisilone rather than Pred Forte, you have to shake the bottle at least 3 to 5 minutes to properly suspend the steroid in solution. otherwise you won't get the right amount of the steroid with each drop.
instilling the drops at the right amount and at the right interval is critical to treatment of iritis. not doing so makes it much more difficult to stop. a VERY SLOW taper off of the steroid is also suggested.
iritis in one eye that is difficult to keep from coming back is sometimes linked to the herpes simplex virus. if you have cold sores then this could be looked into after about six weeks.
you can put a lubricating eyedrop into the eye about 15 minutes after putting in the steroid. wait this long so that you don't wash the steroid out of the eye.
also press in over the inside corner of the eye to plug off the drains so that the eyedrops don't just go down the drain before being absorbed by tissues. you won't have the terrible aftertaste either.

computer use won't have an impact on the eye other than it getting tired because you can't focus well. you also forget to blink so make an effort to do this while on the computer. the surface of the eye dries out when you don't blink and vision can blur etc.
heat has a drying effect on the conjunctiva and the cornea. it won't impact iritis but will increase discomfort from an already dry eye.

the doctor will tell you how much steroid to use and when to use it according to how much inflammation there is. the point at which you go to a corticosteroid sparing approach depends on how frequently you get renewed inflammation or if it remains chronic. usually at about 6 weeks of chronic inflammation they will do testing to see if you might have a known disease or pathogen involved. what drugs are used depends on this as one doesn't want to use DMARD drugs if a pathogen is involved. this is true of steroids as well as bacteria and viruses go crazy in an environment of corticosteroids which also suppress white blood cells.

the uveitis specialist will know what to test you for and what drugs to use. often recurrent uveitis that ping pongs between eyes is related to the HLA B27 gene. NSAIDs such as Celebrex, dolobid or naproxen taken at prescription strength can often help get the eye quiet in this type of iritis when there is no other related disease process going on. forms of arthritis and GI tract problems are also associated with this gene so mention any rashes, joint pain, GI tract concerns such as diarrhea or constipation etc to the specialist so that other tests can be done.

I hope this helps,
Mike