Recurring Iritis and right eye vision is farther than left

[IrisSiren]

Hi Mike,
I'm so glad that i found this forum. First of all, let me say thanks to you for doing such a great service to the community. I would like to share my story and love to hear the suggestions from you.

--First
In 2010 December (My age was 32 and I'm Male), my vision was getting blurry and i waited for 3,4 days and thought it's something minor. But i guess after 4th day it has started becoming really red and really blurry so i went to Ophthalmologist in Pittsburgh (where i live currently). He examined my eye and told me that the pressure in my right eye was way too high and prescribed Prednisolone and Combigan for every hour, every 2 hours and daily etc. Pressure came down in 1 day and he asked me to use the drops for about 4 weeks while reducing the intensity of drops every week. He mentioned it's Iritis. My Dr did all kinds of tests and every thing was fine. He also mentioned that most of the times the cause will be unknown.

I'm visiting Doctor every 6 months and every thing is fine as he says, but i kept complaining that my right eye vision is not same as before 2010 December. He said i probably have astigmatism, slight axis etc. My right eye vision is little farther than my left eye. I can't read subtitles if i close my left eye but i can see and read every thing with my left eye all the time.

--Second
In 2013 April, i got the same issue again in the right eye. And the moment i had the symptoms and i went to the Doctor immediately and this time the pressure was not that high. He prescribed same drops and tapered them off slowly. He told me that i might have a little sight i.e. -0.25 but asked me to use glasses if needed.

--Third
In 2013 August, felt the pressure in my right eye again and immediately went to see the doctor and he checked the pressure and it was about 31 again. prescribed same drops and slowly tapered them off.

This is my 3rd time and i'm really scared of these recurring Iritis. My general physician did all kinds of tests and told me that every thing is fine too.
In 2013 March he did a blood tests for HSV 1/2 and we have found out that i have HSV 1 (>5 Index) but he never mentioned that to me at all. When i was looking at online and i came across this site and understood that this might be related to HSV 1 but not completely sure. As far as i remember I never had outbreaks or any cold sores etc.

Only related symptom for every time that i had eye issue was, really small rash on penis and it went away in 2,3 days. I repeatedly mentioned about small rash/yeast on my penis to both Physician and Eye doctor but they ruled out that issue and told me that it has no connection to eye.

My symptoms now are:
1) Right eye is blurry some times and vision is farther than left eye.
2) Cold feet some times
3) Very tired and less energetic
4) Occasional red dots on genital area(i always thought this was yeast but i guess not)
5) Occasional floaters

Other than these I'm very healthy and absolutely no issues what so ever.

I live in PA and would like to know if there are any specialist doctors that you can recommend in and around Pittsburgh. Please please help me Mike.

Thanks
Justin

[Mike Bartolatz]

HSV is directly linked to iritis in ONE eye that has elevated intra ocular pressure when active. it responds to antiviral medications and it is very important to get on them because this type of uveitis can go to the back of the eye causing Acute Retinal necrosis, Death of the retina. I note that you are in Penn. please contact DR Harper in DC for an evaluation. her contact information is at http://www.uveitis.org in the 'about the support group' section of the site on the USA Specialist list.
next closest specialists are DR Chu, DR Samason or Dr Rosenbaum in NYC. all trained under Dr Foster at Harvard Medical School.

the rash on your penis could be from HSV but I am not a doctor so contact an urologist for consultation.
the only way to treat HSV uveitis is with antiviral meds. many other sexually transmitted diseases can be linked to uveitis. so can Behcet's disease, reactive arthritis but the rashes are different in Reactive arthritis and in Behcet's it is on your scrotum and upper thigh.

wish you the best,
Mike

[IrisSiren]

Thank you so much Mike, really appreciate quick response.
I read somewhere in this forum about specialists that are trained under Dr Foster in Columbus, please suggest. If not I'll schedule an evaluation with Dr Harper as you suggested. Do i need a reference for Dr Foster?
Also, do you think its possible to get my right eye sight back to normal as left eye. Right now, with my right eye i do see objects little farther than left eye.

[Mike Bartolatz]

Dino Klisovic, MD Background Publications
Midwest Retina
500 East Main St.
Columbus, OH 43215
tel. 614-233-9500 fax. 614-233-9501


Dino did train under Dr Foster and I've sent many individuals to him. CAll and tell him that dr Foster's support group sent you as I volunteer There as well as here and ask for an expedited appointment if available. you can mention my name to.

take care,
Mike Bartolatz http://www.uveitis.org http://www.parsplanitis.org http://www.uosg.org http://www.iritis.org

[IrisSiren]

Hi Mike,
I have visited Dr Dino Klisovic last month and he examined my eye and told me that based on my symptoms and flare-up history, he said its most likely HSV1 infection. Luckily there was no damage done to the eyes and he was surprised why my previous dr did not put me on Acyclovir as a precaution. He put me on acyclovir (twice a day, mostly for 1 year for now) and will determine the course of action later. I'm so glad and thankful to you for sending me to Dr Dino. I will be seeing him in 2 weeks again. My most recent flare-up (4th one in 3 years) was 2 weeks after seeing Dino so i will discuss these things with him. I had to visit my old doctor coz I'm not in Columbus but seeing him in 2 weeks. I'm hoping for no more flare-ups with Acyclovir usage.

1) My right eye still sees farther than left
2) i have 1 or 2 floaters most of the time and i get really tired even after sound sleep
3) left eye started getting very itchy for some reason

Do you have any insight on any of these symptoms and are these any specific questions should i ask Dr Dino. My biggest concern is right eye has set farther than left.
Once again thank you so much for the contribution to the community and insight.

[Mike Bartolatz]

with the astigmatism going on , the only correction would be with glasses. the itchy eye could be from dry eyes which can happen from many causes including viral etc. dry environment this time of year with central heating can lead to this. if this is the case, get a humidifier and put it in you bedroom. make sure you clean it regularly with disinfectant though.

you could also try a OTC lubricating eyedrop. I use Theratears brand lubricating eyedrops during the day and Refresh Liquidgel at bedtime.

allergy can be another especially if you have pets or Mold in your home.

if your pressure is up in one eye, that can cause change in vision as it can change the shape of the cornea. dry eyes can also cause vision change and hydrating with drops can help this. also make an effort to blink when on the computer, we forget to blink and the cornea and conjunctiva dry out.

often one uses the aycyclovir and one drop of steroid a day to keep the iritis under control when it becomes active./ don't stop the drug routine. it puts the herpes Sx virus into hibernation and stopping can allow it to come out of hiding. since it is already in the eye, there is a possibility that it could go to the retina and it could blind you through Acute Retinal Necrosis.
not meant to scare you but to reinforce the need to always take your meds.

wish Dino and you the very best,
mike

[IrisSiren]

Thanks Mike. You mean i have to wear glasses rest of my life or temporarily. Also, neither of the doctors were able to confirm if HSV1 is present in my eye. They speculate that it might be HSV 1 related and Dr Dino kept me on Acyclovir on high dose for some time. Will have to see in the next week appointment whether he changes the dose or keep the same.
We are using the humidifier at home but like you mentioned i will start using the lubricating drops.

[Mike Bartolatz]

I wear glasses. ;-( for astigmatism

let me know what Dino says about all of this. He is the one to address these questions. I'm not a doctor, just trying to help get you to doctors that can answer your questions and treat.

take care,
Mike

[IrisSiren]

Thanks Mike,
Dr Dino suggested me to use Acyclovir 800mg/twice a day and use Arlex (Mild Steroid) drops weekly once. He said i may use glasses for astigmatism.

My sincere suggestion to who ever is suffering from ocular pressure, floaters and halos and blurriness, please see your doctor immediately. These symptoms are alarming and needs doctor attention immediately.

[IrisSiren]

I wish i would have started using Acyclovir since my first flare-up. My doctor keep saying he was not sure of the reason even PCP told me HSV1 has nothing to do with eye pressure symptoms that i was having(coz my eye doctor was not seeing any HSV1 symptoms in the eye). Even now he speculates it's HSV1 but not sure. As a precaution my other doctor (Dr Dino) asked me to be on antiviral(acyclovir 800mg) for long and we will monitor if flare-ups reduced over the period of time.

Because of multiple flare-ups i have developed astigmatism in my eye and now i may need glasses. Thank god no major damage done to the eye. I feel confidant that my flare-ups will end with Acyclovir and I will be seeing Dr Dino every now and then. Once again Thank you so much Mike (Can't Thank enough)

[Mike Bartolatz]

Thank YOU for believing what I have told you! most people ignore my suggestions and don't go to real experts. this stuff could have blinded you with HSV1 involved by getting to the retina causing Acute Retinal Necrosis. just remember this so if you vision goes whacky in any way, get in to see Dr Dino Klisovic there in Columbus. visit this site often and tell your story as I need help here as I am once again the only one responding to new members.

wishing you quiet eyes for the rest of your life,
Mike

[IrisSiren]

Hi Mike,
Here is my most recent episode
I have been on Acyclovir (800mg twice a day) for about 3 months now. I had a flare up in February and i have been put on
Pred Forte (4 drops for 2 weeks,3 drops for 2 weeks,2 drops for 2 weeks,1 drops for 2 weeks and the dosage was completed on
April 30 and i have started noticing pressure/Inflammation symtoms on 6th April (1 week after i stopped drops).
Went to see my local Dr and he says i have some inflammation and some KPs and put me back on Pred Forte for (4,3,2,1 drops each week)
And I'm still on Acyclovir 800mg though. My most recent blood work came back clean except lever numbers were little high. I have an
appointment with Dr Dino in mid June.

I'm little confused and nervous about what is going on. Please suggest.

[Mike Bartolatz]

let me know how the appointment with Dr Klisovic goes in June. I too am wondering the cause of the elevated liver enzymes. did they suggest going off the acyclovir? ( I don't know if this could cause any problems).

hope your eyes quiet down soon. what was the IOP in the eye? is it going up? do you have adhesions between the iris and lens that could cause elevated IOP in a herpes virus patient?

wish you the best,
Mike

[IrisSiren]

The pressure is fine in the eye but he (my local Dr) said there's a little bit of inflammation in the eye and couple of KP's on cornea (I'm not sure what that means). Also my Dr said antiviral medication may not be helping.
Note: I just want to let you know that Both Dr Dino and my local Dr did not confirm if it's HSV1, they are just speculating based on the trend.

My only concern is even after being on antiviral high dose for 3 months and 2 months usage of the Pred Forte drops why is it re-occurring? Do you think Alcohol consumption has any thing to do with it (I'm a weekend drinker, 2-3 pegs on Friday and Saturday) or is there anything else that i need to check with Dr Dino.

Elevated lever enzymes might be because of Advil that i took couple of days before the blood work. Apart from that I'm quite healthy and all the blood work looks wonderful.

[Mike Bartolatz]

no alcohol should not be a major problem as long as it is minor.
if it is HSV causing the problem this could be a lifelong battle with bouts of inflammation. the main thing is to keep taking the antiviral as it will keep bouts minor (hopefully) as HSV uveitis can go up a nerve and into the back of the eye causing acute retinal necrosis very quickly. this is also an instance where you may have to be on both antiviral and steroid eye drops for a very long time. it might require low dose, I drop a day of pred forte. the risk of cataract and glaucoma from steroid use is minor compared to the potential for ARN and it's blinding consequences.

wishing you the very best,
Mike