About a month ago I was diagnosed with viral conjunctivitis, two weeks after having a punctata injury in the cornea due to contact lenses on the same eye, for which I was treated with antibiotics. With the conjunctivitis, I had a very red eye, eyelids swollen, preauricular limp node swollen, almost no discharge (although the eyelids did get slightly glued together in the morning) almost no foreign body sensation, or itchiness. On day three, I had stomach ache. On day five, I got it on the other eye, but it was very mild.
About a week after the symptoms started, I visited my doctor. Until then, I had only visited the emergency room where I was prescribed with artificial tears. My doctor confirmed the diagnosis and gave me gatifloxacine y prednisolone for five days in both eyes. I returned to the doctor approximately 12 days after the symptoms started and the doctor told me I had "punctuate keratitis" in the eye where everything started. He told me to continue with the treatment with corticoides in that eye for that month, but to stop the drops on the other eye. I continued with the treatment as indicated by the doctor, reducing the drops gradually from 6 / day to 1 / day in a month.
When I was in the last week of treatment, with only 1 drop / day, I had photophobia in the sick eye. I did not feel pain in the eye or any other symptom. I went to the doctor (I was out of the country so I did not visit my regular doctor) and he told me I had iritis. He gave me Maxidex (1 drop every 4 hours) and a drop to dilate my pupils (1 drop before going to sleep) for five days. I left the drops after seeing the doctor. He told me that "if another doctor sees you again right now, it wont be able to say you ever had anything in your eyes". He told me the iritis I had was very mild and I should not worry about anything.
A day later, the redness returned, but without any other symptom. I used Mazidex and the dilator again just before going to sleep. Next day in the morning I used Maxidex only (it was a weekend so I did not see the doctor). I went back to my hometown that afternoon and I visited the emergency room. The doctor who saw me told me I had nothing. She said "I cannot see any inflammatory processes and you don’t need to continue using the drops".
Next day, the eye was red again (not that much but given the circumstances, I thought it was best to check). I tried to see my regular doctor but it was impossible due to the Christmas holidays, so I went to the emergency room again. This time, the doctor who saw me said I still had the iritis, but that the inflammation was very "weak". She said I had to continue with the maxidex for a week (3 drops / day).
My doubts are whether (i) a viral conjunctivitis can develop into iritis or (ii) if I had iritis all along and I was misdiagnosed. The doctors who saw me for the conjunctivitis said that my case was almost "from the book" suggesting that I filled all the items in the viral conjunctivitis checklist (all symptoms, evolution, etc). The last doctor I saw for the iritis told me that it was probably just a bad coincidence and that the iritis was probably mild because I was using corticoides at the time, but in a dosis that was not enough to keep the iritis down. What she said should have probably been enough, but, to be honest, she did not seem very interested in my case... I just feel too many bad coincidences in the same eye (injury from contact lenses, then viral conjunctivitis and then the iritis) may suggest something else.
On the other hand, and I know is probably because I am to attentive to everything that is happening with my eyes, but I am seeing floaters in the right eye (not the sick one). In the sick eye, also see floaters but they are almost imperceptible. I raised this with the last doctor I saw and she said that I had nothing in that eye and she scheduled a retina check for me in three weeks. Should I consider this normal or could it be the beginning of a new inflamatory process in my other eye?
I am sorry for the long post but I feel very confused, concerned and depressed. The fact that I cannot get an appointment with a doctor until January makes things worse since I cannot get proper guidance. Doctors from the emergency room dont say much and they all seem to have different points of view.
Thank you in advance for your help.
From viral conjunctivitis to iritis?
Moderators: Mike Bartolatz, kwork
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Mike Bartolatz
- Posts: 6595
- Joined: Fri Feb 06, 2004 9:58 pm
Re: From viral conjunctivitis to iritis?
sadly your situation is the norm. the initial problem most likely has progressed to iritis. it is very important to find out if the iritis is of viral cause as it would require the use of antiviral medications. the very short use of sterid eye drops each time is probably why it keeps coming back. a VERY SLOW taper off of the steroids is required in most of us to keep it from coming back. the fact that you see floaters in both eye may well indicate the presence of active inflammation or it could be from early iritis or intermediate uveitis/vitritis. a depressed scleral exam to allow for the look behind the iris would be indicated to see if you have cells present along the Pars plana. if the exudate is present, then it could be intermediate uveitis/pars planitis with spill over into the anterior chamber causing what appears to be mild inflammation in the anterior chamber causing iritis.
intermediate uveitis can be caused by a virus or to other pathogens or inflammatory disease processes. if this keeps coming back or if your photophobia doesn't go away, ask for a referral to a uveitis specialist. a list of them can be found at http://www.uveitis.org located in the patient information section of the site on the USA list of the international list of specialists. if it is caused by a virus it can be very serious and difficult to control and the expert will need to figure out which virus is linked in order to use the appropriate antiviral medication.
use the maxidex as directed and use the dilating drop as the dilating drop prevents the iris from being glued to the lens from the inflammatory process. if the iris sticks a lot, it can cause glaucoma to occur.
wish you the very best,
Mike
intermediate uveitis can be caused by a virus or to other pathogens or inflammatory disease processes. if this keeps coming back or if your photophobia doesn't go away, ask for a referral to a uveitis specialist. a list of them can be found at http://www.uveitis.org located in the patient information section of the site on the USA list of the international list of specialists. if it is caused by a virus it can be very serious and difficult to control and the expert will need to figure out which virus is linked in order to use the appropriate antiviral medication.
use the maxidex as directed and use the dilating drop as the dilating drop prevents the iris from being glued to the lens from the inflammatory process. if the iris sticks a lot, it can cause glaucoma to occur.
wish you the very best,
Mike
Mike Bartolatz
Moderator
Moderator
Re: From viral conjunctivitis to iritis?
Thanks a lot for your message.
I went to the ER at an eye hospital again yesterday to see what to do after the 7 days of maxidex I was prescribed. Only 3 days had passed since my last visit but I am travelling for a week so I needed to know what to do when the treatment is over.
The ophthalmologist who saw me this time told me that he did not see anything in my eye. In principle, he referred me to an uveitis specialist but when I said to him that I would really appreciate some guidance as to what I had, he said that his honest impression was that I was misdiagnosed with iritis and that, for some reason, the previous doctors probably did not link the conjunctivitis with the photophobia and red eye I had at the latest stages of the treatment I was getting for the conjunctivitis. In his view, it makes much more sense to tie the symptoms I had with the previous conjunctivitis, rather than with a completely new disease.
He saw my history (the doctors who initially saw me in the ER for the conjunctivitis gave me one and I saved the prescription my doctor gave me later) and he said it was pretty clear that I had a viral conjunctivitis (follicular reaction, red eye, swollen eyelids, preauricular nodes, etc). He explained that viral conjunctivitis can take several weeks to heal and in my case it probably took a bit longer, re-emerging when the dose of corticoids was too low. An indication is that the preauricular node has not disappeared yet.
He also said that, although not impossible, it was not usual in iritis/uveitis that the symptoms and the inflammation disappear in just one day, as it was in my case (the photophobia and the red eye -the only symptoms I had- disappeared as soon as I instilled the first drop of maxidex and dilating medication, and, when I saw the doctor four days later I apparently had nothing left in my eye).
Regarding the red eye I had after stopping the maxidex, he explained that this is normal after a viral conjunctivitis for the eye to remain sensitive for a wile, as it needs some time to recover. He said that the eye can get irritated because it is dryer than usual and it could take up to two moths to go back to normal. He also said that I can probably have a slightly decrease vision (which I have) during the recovery period as well and that it could take months for my sight to go back to normal.
As to the floaters in my other eye, although he did not check the eye, he said that they are normal and I probably had them before. All the previous doctors had checked this eye and they all said there was no inflammation at all.
He said that, based on what he saw, there was no need for me to continue using the maxidex and that I should stop using it. No tapering at all.
I raised the tapering issue with him and he said that everything should be fine with lubricant eyedrops. He said that if the eye gets very red or if I feel pain, then I should go back to the emergency room, but otherwise, I should forget about my sick eye until seeing my doctor in three weeks and, if my doctor thinks is necessary, then see an uveist specialist. Easier said than done…
So… based on the latest diagnosis, I stopped using my drops last night. I woke up with the eye a bit red but the redness slowly disappeared in the course of the morning.
I am crossing my fingers for the doctor to be right and I hope nothing happens in the forthcoming days/weeks. I have to say that what he said made sense to me. At least he took the time to explain what he thought it was (unlike the other doctors) and he sounded convincing.
I am still concerned about the tapering and the floaters but I am just tired of seeing so many doctors with so many different opinions and I do want to believe the last is right.
I understand that medicine is not an exact science, but I just cannot believe that a doctor specialised in ophthalmology cannot give an accurate diagnosis. The doctor who first diagnosed me with iritis did not sound very convinced about the thing actually being iritis. His explanation to me was that he could not see anything left from the conjunctivitis, and therefore, he thought that the inflammation was "probably" an iritis, but that I should check this with my regular doctor in my hometown. In the check-up four days later, the same doctor said that any doctor would say that nothing ever happened to my eye. Two days after this check-up, a doctor sees me again for the red eye (which I no longer had after two drops of maxidex) and she says there was no inflammation in my eye. Less than 24 hours later, another doctor says the iritis "is still there" and that I had a very "weak" inflammation. Three days later another doctor says I have nothing …. Who should I believe? Aren't ophthalmologist supposed to be able to see the difference between conjunctivitis and iritis?
It is very scary that the doctors cannot give you a proper diagnose. Whatever the right diagnosis is I probably did not receive the right treatment. In addition, if it is just conjunctivitis then in the last two weeks I have been feeling depressed and stressed about the possibility of having a serious underlying condition and recurrent episodes for nothing. If it is in fact iritis, then I am not receiving the right treatment now and I did not receive it a week ago when two doctors told me I did not need the drops.
It is very frustrating and I just want this thing to be over. I hope everything stays normal for the next three weeks when I will be able to see my regular doctor. Even then, with all the different diagnoses I got in the past two weeks, I will probably remain confused. I just want my eyes to stay well.
I apologise for this long cathartic post, but can I just ask you one more thing? If I can attribute the floaters to an iritis/uveitis, how long would it take for the other symptoms to appear? I have been (consciously) seeing them for the past two weeks and, as I said, I had no other symptom of iritis in that eye and the doctors said they found nothing there. I have seen floaters for ages and I always thought they were particles of dust or protein adhered to my contacts. Now that I am not using the contacts anymore then it is clear it is not that and with all the eye problems I had in the last couple of months I have been able to identify it with more precision. I want to believe it is normal as the doctor said but given the circumstances I would really appreciate your advice.
By the way, I tried to make an appointment with one of the specialists listed in the website you mentioned, which happens to own clinic where my regular doctor works. I was told that he does not see any patients unless they are interested in surgery (lasik and cataracts). I think it is disingenious for him to publicise his name on the website when he is not willing to see any patients!
Thank you so much for your support and again, I apologise for the long post.
I went to the ER at an eye hospital again yesterday to see what to do after the 7 days of maxidex I was prescribed. Only 3 days had passed since my last visit but I am travelling for a week so I needed to know what to do when the treatment is over.
The ophthalmologist who saw me this time told me that he did not see anything in my eye. In principle, he referred me to an uveitis specialist but when I said to him that I would really appreciate some guidance as to what I had, he said that his honest impression was that I was misdiagnosed with iritis and that, for some reason, the previous doctors probably did not link the conjunctivitis with the photophobia and red eye I had at the latest stages of the treatment I was getting for the conjunctivitis. In his view, it makes much more sense to tie the symptoms I had with the previous conjunctivitis, rather than with a completely new disease.
He saw my history (the doctors who initially saw me in the ER for the conjunctivitis gave me one and I saved the prescription my doctor gave me later) and he said it was pretty clear that I had a viral conjunctivitis (follicular reaction, red eye, swollen eyelids, preauricular nodes, etc). He explained that viral conjunctivitis can take several weeks to heal and in my case it probably took a bit longer, re-emerging when the dose of corticoids was too low. An indication is that the preauricular node has not disappeared yet.
He also said that, although not impossible, it was not usual in iritis/uveitis that the symptoms and the inflammation disappear in just one day, as it was in my case (the photophobia and the red eye -the only symptoms I had- disappeared as soon as I instilled the first drop of maxidex and dilating medication, and, when I saw the doctor four days later I apparently had nothing left in my eye).
Regarding the red eye I had after stopping the maxidex, he explained that this is normal after a viral conjunctivitis for the eye to remain sensitive for a wile, as it needs some time to recover. He said that the eye can get irritated because it is dryer than usual and it could take up to two moths to go back to normal. He also said that I can probably have a slightly decrease vision (which I have) during the recovery period as well and that it could take months for my sight to go back to normal.
As to the floaters in my other eye, although he did not check the eye, he said that they are normal and I probably had them before. All the previous doctors had checked this eye and they all said there was no inflammation at all.
He said that, based on what he saw, there was no need for me to continue using the maxidex and that I should stop using it. No tapering at all.
I raised the tapering issue with him and he said that everything should be fine with lubricant eyedrops. He said that if the eye gets very red or if I feel pain, then I should go back to the emergency room, but otherwise, I should forget about my sick eye until seeing my doctor in three weeks and, if my doctor thinks is necessary, then see an uveist specialist. Easier said than done…
So… based on the latest diagnosis, I stopped using my drops last night. I woke up with the eye a bit red but the redness slowly disappeared in the course of the morning.
I am crossing my fingers for the doctor to be right and I hope nothing happens in the forthcoming days/weeks. I have to say that what he said made sense to me. At least he took the time to explain what he thought it was (unlike the other doctors) and he sounded convincing.
I am still concerned about the tapering and the floaters but I am just tired of seeing so many doctors with so many different opinions and I do want to believe the last is right.
I understand that medicine is not an exact science, but I just cannot believe that a doctor specialised in ophthalmology cannot give an accurate diagnosis. The doctor who first diagnosed me with iritis did not sound very convinced about the thing actually being iritis. His explanation to me was that he could not see anything left from the conjunctivitis, and therefore, he thought that the inflammation was "probably" an iritis, but that I should check this with my regular doctor in my hometown. In the check-up four days later, the same doctor said that any doctor would say that nothing ever happened to my eye. Two days after this check-up, a doctor sees me again for the red eye (which I no longer had after two drops of maxidex) and she says there was no inflammation in my eye. Less than 24 hours later, another doctor says the iritis "is still there" and that I had a very "weak" inflammation. Three days later another doctor says I have nothing …. Who should I believe? Aren't ophthalmologist supposed to be able to see the difference between conjunctivitis and iritis?
It is very scary that the doctors cannot give you a proper diagnose. Whatever the right diagnosis is I probably did not receive the right treatment. In addition, if it is just conjunctivitis then in the last two weeks I have been feeling depressed and stressed about the possibility of having a serious underlying condition and recurrent episodes for nothing. If it is in fact iritis, then I am not receiving the right treatment now and I did not receive it a week ago when two doctors told me I did not need the drops.
It is very frustrating and I just want this thing to be over. I hope everything stays normal for the next three weeks when I will be able to see my regular doctor. Even then, with all the different diagnoses I got in the past two weeks, I will probably remain confused. I just want my eyes to stay well.
I apologise for this long cathartic post, but can I just ask you one more thing? If I can attribute the floaters to an iritis/uveitis, how long would it take for the other symptoms to appear? I have been (consciously) seeing them for the past two weeks and, as I said, I had no other symptom of iritis in that eye and the doctors said they found nothing there. I have seen floaters for ages and I always thought they were particles of dust or protein adhered to my contacts. Now that I am not using the contacts anymore then it is clear it is not that and with all the eye problems I had in the last couple of months I have been able to identify it with more precision. I want to believe it is normal as the doctor said but given the circumstances I would really appreciate your advice.
By the way, I tried to make an appointment with one of the specialists listed in the website you mentioned, which happens to own clinic where my regular doctor works. I was told that he does not see any patients unless they are interested in surgery (lasik and cataracts). I think it is disingenious for him to publicise his name on the website when he is not willing to see any patients!
Thank you so much for your support and again, I apologise for the long post.
-
Mike Bartolatz
- Posts: 6595
- Joined: Fri Feb 06, 2004 9:58 pm
Re: From viral conjunctivitis to iritis?
private message me with the name of the doctor that only does cataract and laser surgery. but, in my many years of doing online support I have run into several instances where the 'gate keeper' gave erroneous information out about specialists and even not allowing individuals to make appointments. when the doctors have been contacted, we have been informed that the individual was incorrect and that they are still uveitis specialists who truly wish to continue to have referrals from us.
I don't know what to say about whether this is conjunctivitis or if it is uveitis present. depending on your age, it may not be 'normal' for you to have floaters. do you have nearsightedness that could explain floaters at a younger age? if far sighted it shouldn't increase floaters. only an expert can guide you as to why you have a lot of floaters. often they remain after a first bout of uveitis and are 'old cells'.
severe dry eyes causes a red eye from degradation of the conjunctiva by abrasion between the eyelid and the conjunctiva. then bacteria or viruses can enter and an infection can occur. did the doctor actually test you to determine how dry your eyes are? they put litmus paper in the corner of your eye for a specific amount of time and then 'read' how far the tears have moved up the paper. if very little you have very dry eyes. this can be from disease linked to uveitis as well as to viruses. you mentioned nodules on the surface of the eye, these too can sometimes be linked to autoimmune diseases or inflammatory disease processes. if they remain get them biopsied.
as to the dry eyes, get a very good quality of lubricating eye drops. I personally use Refresh brand Liquidgel eye drops at night. these prevent my eyelids from sticking to my eyes (very painful). then I use Theratears lubricating eye drops periodically throughout the day.
once your eyes heal use these before putting in your contacts.
often dry eyes leads to blepharitis, the crusties on your eyelids or in the corner of your eyes in the morning. get some baby shampoo and mix it with very warm water. use a washcloth to apply this mixture and gently massage along the lash line. this will help to unplug the meibomian glands located along the lash line, instill a drop of lubricating eye drop prior to doing this so that the thickend lubricant will have something to mix with. this will also help with the 'scratchy' sensation that the thickened lubricant causes.
do this about four times a day for about a month or so.
please tell me where you live so that I can suggest an Uveitis specialist near you for a consultation. you may have to travel as these specialists (the good ones) are few and far between.
wish you the best,
Mike
I don't know what to say about whether this is conjunctivitis or if it is uveitis present. depending on your age, it may not be 'normal' for you to have floaters. do you have nearsightedness that could explain floaters at a younger age? if far sighted it shouldn't increase floaters. only an expert can guide you as to why you have a lot of floaters. often they remain after a first bout of uveitis and are 'old cells'.
severe dry eyes causes a red eye from degradation of the conjunctiva by abrasion between the eyelid and the conjunctiva. then bacteria or viruses can enter and an infection can occur. did the doctor actually test you to determine how dry your eyes are? they put litmus paper in the corner of your eye for a specific amount of time and then 'read' how far the tears have moved up the paper. if very little you have very dry eyes. this can be from disease linked to uveitis as well as to viruses. you mentioned nodules on the surface of the eye, these too can sometimes be linked to autoimmune diseases or inflammatory disease processes. if they remain get them biopsied.
as to the dry eyes, get a very good quality of lubricating eye drops. I personally use Refresh brand Liquidgel eye drops at night. these prevent my eyelids from sticking to my eyes (very painful). then I use Theratears lubricating eye drops periodically throughout the day.
once your eyes heal use these before putting in your contacts.
often dry eyes leads to blepharitis, the crusties on your eyelids or in the corner of your eyes in the morning. get some baby shampoo and mix it with very warm water. use a washcloth to apply this mixture and gently massage along the lash line. this will help to unplug the meibomian glands located along the lash line, instill a drop of lubricating eye drop prior to doing this so that the thickend lubricant will have something to mix with. this will also help with the 'scratchy' sensation that the thickened lubricant causes.
do this about four times a day for about a month or so.
please tell me where you live so that I can suggest an Uveitis specialist near you for a consultation. you may have to travel as these specialists (the good ones) are few and far between.
wish you the best,
Mike
Mike Bartolatz
Moderator
Moderator