13 years of Iritis - Does it ever end?

[jljaries]

Hi
I'm 47 yrs old (male) and have had iritis for a little over 13 years now.
It started in the right eye, which has been my lazy eye all my life.
After after about four years of recurrent flare-ups, I had a retinal detachment
followed by cataract surgery about 2 years later.
After that , I started getting flare-ups in the the left. (my better eye).
About 2 1/2 years ago, I started getting ocular-hypertension. IOP in the 40s & 50s.
I had to have tube-shunt surgery. Then, I had cataract surgery about a year after that.
Also during this time I started to have severe dry eye.
My ophthalmologist suggested Congenital Rubella Syndrome might be causing my problems and that they were lens induced. I also have optic disc colobomas in both eyes. So, it seemed to fit. I also have retinoschisis in the left eye.
About 7 months ago, after being pretty quiet for years, my right eye starts to have some
inflammation at the same time as the left. So, maybe it’s not the CRS.
I have known about being HLA-B27 pos for only about 4 years now and have been reading this site for about that long now.
I still have no idea why this is happening. NO diagnosis has been made.
My HMO (Kaiser - Northern California) has no ocular immunologist, that I know of, and I have trouble traveling due to all the eye/vision problems and chronic fatigue.
The rheumy I saw the first two times didn't run any tests and ended up prescribing Sulfasalazine
without a real diagnosis. And it didn't help.
Two month ago, I got a second opinion from a different rheumatologist.

Still nothing! After all these tests.

Test results of Sept-2010 visit with rheumatologist.

LUPUS ANTICOAGULANT NEGATIVE NEGATIVE-

CK 62 0-200 U/L

TSH 1.03 0.10-5.50 uIU/mL

CYCLIC CITRULLINATED PEPTIDE IGG 4 <20- Units

C3 182 83-180 mg/dL

C4 45.2 10.0-40.0 mg/dL

HLA-B27 (FLOW CYTOMETRY) PRESENT (already knew this - confirmation)

TOTAL HEMOLYTIC COMPLEMENT CH50 55 24-84 U/mL

C-REACTIVE PROTEIN,SER,QL 0.4 <0.5- mg/dL

DNA DS AB, IF NEGATIVE

SJOGRENS-A AB, SER, QL, ID NEGATIVE

SJOGRENS-B AB, SER, QL, ID NEGATIVE

RNP AB,SER,QL NEGATIVE

SMITH IGG, SER QL NEGATIVE

CARDIOLIPIN AB, SERUM NEGATIVE

ALDOLASE 2.5

NUCLEAR AB,SER,QL NEGATIVE

RHEUMATOID FACTOR 6.7 <14.0- IU/ml

ULTRASENSITIVE C-REACTIVE PROTEIN 4.6 <3.0- mg/L

ESR 16 0-15 mm/Hr (the highest it's ever been)

Did he miss anything ?
What other test should/could be done ?

My xrays show only some arthritis or degenerative changes in my lumbar, thoracic
and cirvical spine.
Iritis is bad enough. At least you know you can get some relief.
The dry eye is a miserable condition. I have some good days, but mostly not.
The pain and photophobia are much more persistent with dry eye.
I've tried Restasis and Doxycycline. Nothing gives any lasting benifit.
Most of the artificial tears just dry on your lashes and cause more irritation.

RIght now, I’m doing my best to keep working. I’d rather not go on disability, but it seems
I might have to someday.

I would appreciate feedback.

Thanks, JJ

[Mike Bartolatz]

JJ welcome to the group!
one can be HLA B27 positive and not develop ankylosing spondylitis, reactive arthritis, psoriatic arthritis, chron's disease or ulcerative colitis.
degenerative changes are from wear and tear and trauma. can you get to one of the specialists at http://www.uveitis.org listed in the PATIENT information section of the site? Ira Wong is in SF. have you tried NSAIDs such as celebrex, dolobid or naprosyn at prescription strength for about 6 months to see if it can break the cycle of inflammation? DMARD drugs such as Methtrexate, cellcept etc are used to break the cycle too. the dry eyes could be caused from the HLA B27 which can predispose to uveitis. it takes Restasis about 6 months to work in many individuals. sometimes Methtrexate will also help with lacrimal gland inflammation which causes poor tears to occur. especially if something such as Sarcoidosis is the cause.

have you tried systane lubricating eyedrops that are NOT the gel type used at bedtime? how about punctal plugs to close off the drains of the eye (these were a godsend for me)? I use the gel type of lubricating eyedrops at bedtime and just lubricating eyedrops during the day as needed. Yes severe dry eyes does suck!

please join us in our various forums to reply as only moderators can post resonsed in the INTRODUCTION forum,

Take care,
mike