Iritis Again!?!

[naheed]

Hey Everyone,

I'm 24 years old born and raised in Edmonton, Alberta, Canada, and had my first encounter with irits when I was 17. It went away after a few weeks of Pred Forte drops and a nighttime ointment. When it came back a little while later, my ophthalmologist had me do all these blood tests which all came back negative. Over the next few years it came and went, I'd say about 6-8 months apart at a time - always worse in my right eye - the left eye always responded well to the steroid drops. One flare up (I think I was 19), drops in the right eye didn't seem to be bringing down the inflammation - and I was taking them every hour for about 2 or 3 weeks. My doctor gave me cortisone shot in my right eye - the inflammation finally subsided. At this point there was quite a bit of adhesion going on between the iris and the lens (when I was on dilating drops, the pupil wasn't completely round). Also I was seeing a lot of floaters. And on top of that my vision wasn't very good at all.

Not long after that, due to all the steroid treatment in the right eye, I had to get cataract surgery followed by a YAG laser. My doctor indicated that he was able to break down the adhesion that had formed as well. About 2 years after the surgery, I had a bad flare up - I needed another cortisone shot - which thankfully worked. But, I've been pretty good for the past 3 years, with barely any flare ups. Usually they would be pretty mild and with drops, the inflammation would go away after a week or so.

About a year ago, my job transferred me to Houston. With no flare ups in about 18 months, I decided to visit Dr. Lewis (after checking out this site) just to get his opinion of everything going on. He's been really great. He did see a few cells in both eyes and decided on a plan: for the time being, to take one steroid drop every day in both eyes. His concern was that my left eye would flare up out of control as bad as my right in the past. And this seemed to be working very well. I saw him 2 more times over the next 8 months without any changes - he said on the 1 to 4 scale, I would be a 1, and the one drop a day seemed to be working.

About two months after my last appointment (about 3 weeks ago), I woke up one morning seeing a white haze and tons of spots in my left eye. I quickly got in to see Dr. Lewis and I got started on treatment again: just 4/day in the left and 2/day in the right. I was also on a 5% homatropine dilating drop twice a day in the left - adhesion was now becoming a problem. I guess there was always a bit of adhesion going on but now it was very apparent as I could barely focus on anything close up. I saw Dr. Lewis after 10 days of treatment with the drops and he said I was completely clear – now we’ve reduced the drops to twice a day in both eyes until I see him next (December 2nd).

Currently, my eyes seem to be pretty clear except for one thing, since last time I saw the doctor, I was on dilating drops I didn’t really notice. But now that the atropine has worn off, I’m still seeing tons of spots in my left eye. I’m not sure if it’s cells from the iris that are sticking to the lens or floaters, or what. But I know they definitely weren’t there before this last flare up. Do you guys think it’s worth going to see the doctor again before my next appointment because of these spots? On a side note, I’m also going home for Thanksgiving so I figured it’d be a good idea to get my test results – those original tests they did when I was 17 – I’m not sure if I was tested for the HLA B27 gene. I really do apologize for the long post. I guess I just get frustrated every time my eyes flare up and I needed a place to vent!

--Dr. Lewis may be trying to get my iritis completely controlled first before trying other treatments - but thank you so much for the advice!

[Mike Bartolatz]

There is a canadian doctors list in the SPECIALIST forum of this site. you can make an appt with DR Heston in Edmonton and get the tests done. it could well be that you have the HLA B27 gene. have you tried NSAID therapy to see if that will stop the inflammation in your eyes, a six month trial of Celebrex, Dolobid or Naprosyn at prescription strength might keep the uveitis at bay, then stay on teh NSAID for TWO YEARS off all steroids to retrain the immune system to stop attacking your eyes.
as an aside, I had hoped that Dr Lewis would do this for our members when chronic iritis occurs that is autoimmune in nature as outlined By DR Foster's treatment Algorithm. Dr Heston has worked with DR Foster in Boston/Cambridge. Dr Foster is the TOP ocular immunologist in the World BTW.

Wish you the best,
Mike