Chronic Iritis

[chicoharv]

I was diagnosed With Iritis back in December of 2012and continue to get recurring outbreaks after it disappears, 7 out breaks since then. It clears up after steroid drops for a couple of months only to reappear within a month. It is only in my left eye. I had lattice retinas diagnosed back in 2001 and have had laser surgery in both eyes to correct this after retina tears. My left eye has a scleral buckle around it and both eyes have had lens replacements for cataracts aged by the laser treatment. My ophthalmologist does not think the buckle could cause this but I am not convinced. Any recommendations would be appreciated.

[Mike Bartolatz]

you might want to contact an Ocular immunologist for consultation. you have so much going on in that eye that you need the very best doctors to work with you to get you to remission. if you are in California DR Narsing A Rao at Doheny eye institute would be an excellent choice as he is a retina specialist and uveitis specialist.

any form of surgery to the eye is very traumatic and trauma is the primary cause of uveitis.
DMARD drugs are used to implement a corticosteroid sparing approach to treatment in recurrent or chronic inflammatory eye diseases. a couple of other doctors in California are Dr Levinson in LA and dr Ira Wong in SF.

all of the above doctors can be found at http://www.uveitis.org in the patient information section of the site on the Specialist list. If you aren't in California, tell me where you live and I'll tell you the best doctors near you for a consultation.

wish you the very best,
Mike

[chicoharv]

Thanks for the info. I am in Northern Calif. and my wife has a appointment at UCSF for her spinal problems on March 17th so when I see my Ophthalmologist next week I will see if he will refer me to the Proctor clinic with Dr. Acharya or Gonzales for the same day as we have to drive 4 hours and stay overnight for most visits. Every time I get a flareup I start the steroid drops and its usually 2 weeks later that I can get an appointment with my Ophthalmologist6 to verify I had a flare up and another 8 weeks before there are no cells to detect. then within a month it usually starts back again to start all over.

[Mike Bartolatz]

have you been tested for the HLA B27 gene? does inflammation go from one eye to the other?

can you see Ira Wong at proctor? he is the top ocular immunologist near you.

have you tried oral NSAIDs such as Celebrex, Dolobid or Naproxen at Prescription strength to see if you can break the recurrent nature of your uveitis before it starts damaging the inside of your eyes?

wish you the best,
Mike

[chicoharv]

Thanks again Mike
No I have not tried NSAIDS at Prescription strength. It does not go from one eye to the other, it stays in the left eye, the one with the scleral buckle that was installed in 2001. Nor have I been tested for the HLA B27. I will definitely try to get Ira Wong but I need to do something before it does more or permanent damage or loss of sight. I also don't want to get glaucoma from the overuse of Steroids. I also have VA insurance that might cover this if medicare doesn't.
Harvey Nelson

[Mike Bartolatz]

any chance it could be from a virus like the herpes sx virus that causes cold sores?

my best,
Mike

[chicoharv]

I don't think so as I have annual blood tests and donate plasma every week. I am seeing mt GP on Thursday and will discuss this with her.

[Mike Bartolatz]

the cold sores would be on your lip or on you nasal passages if you get them.
have they tested you for things associated with chronic iritis? autoimmune diseases? arthritis? skin rashes? nervous system problems?

mike

[chicoharv]

I have a negative reading for the b27 gene but I do have artritis. I have an appt to see Dr. John Gonzales in San Francisco on the 17 of March. Dr. Ira Wong is not associated with the Francis Proctor Clinic any longer and Dr. Gonzales has all Dr. Wongs patients now. My Iritis went into remission after 16 days of steroids now I am tapering off the drops. My ophthalmologist here and I seem to think the scleral buckle may be contributing to the recurring infection but why did it take 11 years to cause it. As you said my eye has had a lot of trauma.

[Mike Bartolatz]

thank you for the information about Ira Wong. I will pass this on to the Ocular Immunology and Uveitis Foundation so that the list of specialists can be updated.

let me know how the appointment goes with the new doctor.

hoping your eyes remain quiet.

my best,
Mike

[chicoharv]

Mike I had my exam by Dr. Gonzales on the 17th at the Francis Proctor Institute of UCSF. He has increased my drops to I every hour while awake and also prescribed cyclopentolate, 2 drops per day until I see him again on April 1st. I also had a chest xray and complete blood test performed today per his direction. He wants to rule out other causes before we see if I have a autoimmune problem. I mentioned to him I was a frequent plasma donor and he said that was ok. When I went to donate plasma today, the blood center doctor stopped me from donating until the results of my test and a formal ok from Dr. Gonzales after I see him. They are more worried about my donating the plasma is affecting my fighting the infection than giving some one else something. Plasma is used to fight infections of course and I maybe be compromising my own immune system. I sure am glad I got a referral to Francis Proctor even if it is a 4 hour drive each way. I'll let you know what happens after the 1st.
chicoharv

[Mike Bartolatz]

Chicoharry,
please do let us know how your blood tests go. I am also concerned because of how bad your inflammation must be to require hourly steroid eye drops. for your information, please put in a drop of steroid, then with your head back and your eyes closed, press in over the inside corner of your eye. this will plug off the drains. hold this for about three minutes, then do the same in the other eye. this allows the steroid to be absorbed by the eye and surrounding tissue so that it does not go down the drain and causing the terrible aftertaste. wait about 15 minutes before putting the dilating drop in your eye too. repeat the process outlined above so that it too doesn't just go down the drain. I know this is an annoying way of doing the eye drops stuff but it will help your eyes to heal quicker.
the blur of vision from the dilating drop can be problematic. make sure you wear wrap around sunglasses while outside to prevent the sunlight from burning your retina while your eyes are dilated. use dark green or gray on sunny days and brown on overcast days and while on the computer to help with glare. yellow tinted glasses help In fog and at night.

if you have been in the desert area of California or the southwest of the USA or northern Mexico, Valley fever can cause uveitis.
if you have cats or dogs, they too can cause problems from Toxocara infections. this is a form of roundworm. cats also can cause cat scratch disease from the B. Burdgorferi pathogen. It is related to the pathogen that causes lyme disease, B henselae (sp).
H. Pylori can also cause iritis and it can be detected in the fluid of the anterior chamber. this is a gut bacteria that causes stomach ulcers, and can also be found in atherosclerotic plaque in arteries. Toxoplamosis is another pathogen as are Tuberculosis both human and Bovine. T Bovine has been introduced into the USA from Mexico and only impacts latino's. usually in unpasteurized cheese from Baja peninsula.
northern California also has a mold that can cause iritis Cryptospirosis if I recall correctly. they probably tested you for sexually transmitted disease (routine in all with iritis) too.

I hope this helps,
mike

[chicoharv]

Mike , thought I better let you know what has happened since my last post. Things aren't going to well now.
In the 1st of May I saw Dr. Gonzales again and he said all test were negative and to go down to 2 drops a day. 3 days later my left shoulder and upper arm felt like arthritis was acting up. The next day my vision blurred up and arthritis subsided. the next day I called the Proctor institute as my Dr. here is a 7 day adventis and closed on Fridays. Dr. Gonzales was at a medical convention in Miami with most of the staff. A Dr. Shehan called me in the evening and told me to go back to every hour with the drops and dilator.I saw him a few days later and he had me go on a weekly regimen of 6drops a day for a week then 4 drops a day for a week then 3 drops a day until my next visit June 3. Saw Dr. Gonzales and he discussed with me the options, he said the eye was quiet enough that a sample of the eye fluid would probable be negative so he put me on 3 drops a day for two weeks along with Valacyclovir 3 times a day. The next day I took one pill to only find out I am allergic to acyclovir within the hour. Called the institute and got a call back in the evening from Dr. Shehan again saying that after the reaction clears up to try a related drug called Famciclovir which seems to be tolerated by some allergic people. I have been taking benadryl and I still have the rash but the itching has subsided so in a day or two I will try one Famciclovir. My next store neighbor is a Pediatrician and she suggested I buy some L-liacine as she has babies with Herpes S that can't take acyclovir and it keeps the Herpes from flaring up. So that is where I stand for now. Dr Gonzales is having a round table of associates there when he sees me next. Maybe I have them stumped. Their other suggestion is if it flares up to go down there and get a sample of my eye fluid taken while the flare up is very active.
chicoharv

[Mike Bartolatz]

Sorry for you allergic reaction to the acyclovir. hopefully the Famavir will work for you. you might want to take it in the presence of a doctor though in case of allergic reaction.

too bad your doctor hadn't put that 'take sample when flaring up' in your chart, then you would be a step ahead now.

let me know how things go,
Mike

[chicoharv]

Mike Last Sunday I had a flare up while on 2 drops per day . Monday I drove to SF to see Dr. Gonzales. He took a sample of my eye fluid and sent me home to try Famcyclovir. I tried it the next day at my PC doctors ofc. After 2 hours no reaction but when I got home after 5 hours I got the rash and itch. The Clinic said I had a viral problem and I was in a bad spot until I see an allergist and get desensitized for the acyclovir family of drugs; so I will see one tomorrow here in Chico. I believe the virus is from Herpes Z, for shingles. about 2 years ago I got the immunization for shingles so I was hoping I was clear. I will know more in a month or so I hope.