iritis.com: Iritis and uveitis information page

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Web Name: iritis.com: Iritis and uveitis information page

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This site provides information on iritis and uveitis, and theconditions associated with these eye diseases. There are message boardswhere questions may be asked and experiences shared. It is provided as aservice to patients worldwide by an ophthalmologist in England.Click here toenter iritis.comYou shouldn't have scrolled down so far! This following text is mainlyintended for search engines to index, and may not be the latest versionsiritis (uveitis) is a common eyecondition in which the iris is inflamed. This site aims to draw togetherpatients who suffer from iritis (uveitis), and doctors who treat it.I started this sitebecause many of my iritis (uveitis) patients clearly wanted to know more about theircondition. However, in a government hospital setting there is never enough timeto explain things as much as one would wish. I also started this site becausefor many patients, being able to discuss their condition with others istherapeutic in itself. For those people with iritis (uveitis) associated with medical conditions, links to self-help and advice groupsare given.While all information is givenfreely and in good faith, I cannot be liable for the information given on thissite, as the information is not tailored to your particular condition.This is not the only iritis (uveitis) site on the net – other sites are listed in the directory of externallinks – but it is the only site started and maintained by an ophthalmologist.I hope you find it helpful.Dr Victor Chua MA (Cantab), MB BChir (Cantab), MRCSE (Ophth.)Cambridge, England16 June 2000is iritis (uveitis)?have diagnosed that you have a condition known as iritis (uveitis). Thisis a condition where a part of the eye, the iris,becomes inflamed. proper treatment an attack of iritis (uveitis) can be controlled.What are the signs of iritis (uveitis)?Itis more common for just one eye to be affected during an attack of iritis (uveitis).However both eyes can be affected at the same time. Generally,the eye is not sticky, crusty orproducing a discharge. These are symptoms more suggestive of conjunctivitis.What is the iris?The iris is the structure behind the cornea of the eye which dilates andconstricts. In bright light, the iris constricts (you may have noticedthis yourself). In dim light, it dilates.What is the difference between the iris and the pupil?The pupil is defined as the the hole in the middle of the iris. Theiris is the structure which is around the hole and defines the hole.there different kinds of iritis (uveitis)? What is the difference between iritis (uveitis) and uveitis?Yes. iritis (uveitis)is the commonest of a family of conditions called uveitis. The uveaextends from the front of the eye to the back of the eye. Where the uvea isinflamed at the front of the eye involving the iris,uveitis is synonymous with iritis (uveitis).Where it inflamed near the middle of the eye involving the ciliarybody, it is called cyclitis. Whenthe back of the eye involving the choroidis inflamed, it is called choroiditis.are the causes of iritis (uveitis)?Veryfew people with iritis (uveitis) have a contagious variety. If you do, your doctor willtell you.attacks of iritis (uveitis) be prevented?speaking, no. No-one knows why people have recurrent attacks at particulartimes. There is published evidence that earthquake victims have much higherrates of recurrence so some doctors think stress may be a factor.is iritis (uveitis) diagnosed?symptoms occur, a prompt examination by an ophthalmologist (medical doctorspecializing in the eye) is important. If left untreated, inflammation in theeye can lead to permanent damage or even in extreme cases blindness.Theophthalmologist will use instruments to examine the inside of the eye and canusually make the diagnosis on that basis. Since uveitis can be associated withdisease elsewhere in the body, he will require a thorough understanding of youroverall health. This may involve consultation with other medical specialists. Hemay also request blood tests, X-rays, and other specialized tests to establish acause of the uveitis. is iritis (uveitis) treated?[Maxidex]) and pupildilators, are medications used to reduce inflammation and pain in the front ofthe eye. The steroid drops may need to be instilled frequently (in severe casesas much as every half an hour). Your ophthalmologist will arrange to see youagain to assess the progress of the treatment and will, according to the degreeof inflammation, decrease or increase the treatment.Pupildilating drops (such as Cyclopentolate [Mydrilate] or Atropine) make you feel morecomfortable and prevent certain complications of iritis (uveitis). However you may becomemore sensitive to bright light, especially during the summer, and you may losethe ability to focus on near objects (accommodation),and your vision may become more blurred.Aren’tsteroids harmful?taken by mouth have side-effects. However steroid eye drops are absorbedprincipally by the eye and do not cause the same side-effects as oral steroids.In a small proportion of people steroid eye drops cause the pressure in the eyeto rise above normal. Your ophthalmologist will measure the pressure in the eyeto discover if you are one of these people and will treat you accordingly.are the possible complications of uveitis?complications may themselves need treatment. If complications are advanced,conventional or laser surgery may be required.is the probable outcome?arising in the front or middle of the eye (iritis (uveitis)or cyclitis) is commonly more suddenin onset, generally lasting six to eight weeks, and in early stages can usuallybe controlled by the frequent use of drops. Often, this type of uveitis cannotbe given a specific cause.Uveitisin the back part of the eye (choroiditis)is commonly slower in onset and may last longer, and is often more difficult totreat. Treatment may involve steroid tablets or injections. Often, multipletests are required to find the cause of this type of uveitis.Withinfections, uveitis tends to clear up once the underlying infection is treated.there any restrictions to what I can do?should not drive a car if you can’t see properly. Dark glasses will make youfeel more comfortable. Whether you will need to give up work depends on theseverity of the symptoms. There is no special diet required.Backto iritis (uveitis).com homeTypes of iritis (uveitis)iritis (uveitis) may be associated with the conditions listedbelow. However, it is important to realize that the majority of casesof iritis (uveitis) have no known association.If your ophthalmologist has reason to suspect thatyou have an associated condition, he may request tests such as blood tests andx-rays to confirm the associated condition.The information given in the headings below apply onlyif you have the known associated condition. Some of them are very rare. The morecommon associations are listed first. B27 iritis (uveitis)50% of iritis (uveitis) sufferers are positive in a bloodtest that looks for a protein found on cell surfaces called HLA-B27 . B27 is also associated with the following conditions: Ankylosing spondylitis Psoriasis Ulcerative colitis Crohn's disease Reiter's syndromeNon-infectious associations Fuch's heterochromic iridocyclitis Intermediate uveitis SarcoidosisThe following are very rare in the Western world Behçet's disease VKH (Vogt-Koyanagi-Harada) diseaseThe following association is very rare, full stop Multiple sclerosisInfections associated with iritis (uveitis) Herpes simplex (cold sore) Varicella zoster (shingles)The following are very rare Tuberculosis (TB) Acquired syphilis Leprosy Lyme disease Toxoplasmosisiritis (uveitis) due to injuryAn impact or penetrating injury to the eye may cause iritis (uveitis). As aninfection may mimic iritis (uveitis), it is vital that an ophthalmologist be consulted ifthere is any possible doubt about ocular penetration.iritis (uveitis) due to surgeryAny intra-ocular surgery, such as cataract extraction or trabeculectomy forglaucoma, will cause some degree of iritis (uveitis) for a few weeks after surgery.To reduce inflammation your eye surgeon will prescribe steroid drops to reducethe inflammation. Exact regimes differ from surgeon to surgeon.iritis (uveitis) in children Juvenile chronic arthritis (in USA, Juvenile rheumatoid arthritis)Backto iritis (uveitis).com homeWhat is iritis (uveitis)?There is a whole page devoted to this. Clickhere.Why is the font size in iritis (uveitis).com so big?This is because many patients with iritis (uveitis) have poor vision, or are usingdilating drops which reduce near visual acuity. If it is too big (or toosmall), you can change the textsize in your browser. For example, in Microsoft Internet Explorer selectView from the menu and then Text Size.What is the difference between iritis (uveitis) and uveitis? Sometimes I am toldI have iritis (uveitis), sometimes I am told I have uveitis, but the symptoms are the sameto meiritis (uveitis) is a kind of uveitis, specifically it is the same as anterioruveitis . There are three types of uveitis - anterior, intermediate,and posterior. Intermediate and posterior uveitis are rare conditions. iritis (uveitis)anterior uveitis) isa common condition.Isn't iritis (uveitis) due to an infection? I thought most diseases ending in -itiswere caused by infectionFew cases of iritis (uveitis) are caused by infection, althoughinfection is a rare cause. The -itis suffix actually denotes inflammation,which is not the same as infection. Infection is caused by an external organisminvading the body. Inflammation is one response of the body to infection.Unfortunately, inflammation may occur when the body's immune system targetsitself inappropriately. In most cases of iritis (uveitis), it is the inappropriate targetingwhich occurs.What are the functions of the drops I have been prescribed?There are many drops used in the treatment of iritis (uveitis). The two main kinds ofdrops used in iritis (uveitis) are Steroid drops Dilating dropsSteroid dropsSteroid drops (also known as corticosteroid drops) are used to decrease inflammation, which is the cause of painand redness of the eye. Steroid drops come in different varieties and strengths,and may be taken as often as every half an hour or as infrequently as twice aweek. For most attacks of iritis (uveitis) your ophthalmologist will advise steroiddrops every two hours or so for the first few days.Examples of steroid drops (brand names in [brackets]): Prednisolone [PredForte; Predsol is a weaker formulation] Dexamethasone [Maxidex] Betamethasone [Betnesol] Fluoromethalone [FML] Hydrocortisone [Neo-Cortef] Clobetosone butyrate [Cloburate] Rimexolone [Vexol]Dilating dropsDilating dropsare used to relax (ie. make large) the pupil and theciliary musle. There are two reasons for this: first, relaxing the pupil helpsprevent the formation of posteriorsynechiae, and second, relaxing the pupil and ciliary muscle decreases thepain associated with iritis (uveitis).Dilating drops have differing duration of action, noted below: Atropine (1 week) Homatropine (1 day) Cyclopentolate 0.5% [Mydrilate] (8 hours) Tropicamide 1% [Mydriacyl] (6 hours)The duration of action given is approximate. For example, the effect ofatropine may wear off in a few days in some people, a few weeks in others.Are there any side effects from steroid drops?About 5% of the population are steroid responders , meaning thatthe intraocular pressure goes up when steroid drops are used. Yourophthalmologist will measure your intraocular pressure on your first two visitsto determine whether you fall into this group.If you are a steroid responder, your ophthalmologist may prescribeanti-glaucoma medication to bring the pressure down, or he may prescribe aweaker steroid such as FML. A new steroid drop, Rimexolone, which has highpotency but low potential to increase pressure has come on the market.If you are a steroid responder, you should remember this fact and mention itto your ophthalmologist on your next visit so that he can take appropriateaction to minimise a rise in pressure.Other side effects are few. The purpose of steroid drops is to decreaseinflammation. Therefore, while you are on steroid drops your resistence toexternal infection will be reduced. Since the wearing of contact lenses mayencourage infection, contact lenses should not be worn.Are there any side effects from dilating drops?Blurred vision is the main side effect. Some people may notice dry mouth. Insome people (especially those given atropine) some slowing of the heart beat mayoccur.The last time I had iritis (uveitis) I was given steroid drops. However, for my mostrecent attack I was given different steroid drops! Why?The different steroid drops have differing strengths: PredForte and Maxidexare at the strong end of the scale, Betnesol and Predsol are in the middle, andFML is a weak steroid. They have slightly different penetration characteristics.Your eye doctor will have a preference.Probably the commonest drops used in the UK for the treatment of iritis (uveitis)PredForte and Maxidex. There is little to choose between them in strength. Somedoctors and hospitals prefer one drop, some another. When I used to workin East Anglia, I prescribed Maxidex; when I moved to the Midlands I startedprescribing PredForte mainly because it was advocated by the local iritis (uveitis)expert.Many ophthalmologists (including myself) don't think there is very muchdifference between PredForte and Maxidex. There is little or no convincingresearch to demonstrate any superiority of one over the other.The last time I had iritis (uveitis) I was given dilating drops. However, for my mostrecent attack I was given different dilating drops! Why?Again, the preferences of your ophthalmologist will have a large part toplay. The main difference between the various kinds of dilating drops lies intheir duration of action. There are also significant differences in the severityof their side effects.When I used to work in East Anglia, I prescribed cyclopentolate 1% to peoplewith simple uncomplicated iritis (uveitis). When I moved to the Midlands, atropine was thestandard dilating drop at my new hospital so I started prescribing it instead.The main difference was that people on cyclopentolate recovered sharp visionsooner on discontinuing the drop as it only lasts 8 hours on average. People onatropine had to wait a week. However, there is little or no convincing evidenceto demonstrate any long-term advantage of one dilating drop over the others.If you have had particular preferences for one type of dilating drop in thepast, you should mention this to your ophthalmologist.What about non-steroidal anti-inflammatory drops?These are sometimes used in place of steroid drops in mild cases of iritis (uveitis).Examples are Diclofenac (Voltarol ophtha) and ketolorac (Acular).My vision has not got better despite the treatmentThe aim of iritis (uveitis) treatment is not short-term restoration of vision, butrather the long-term preservation of vision. Very often, the vision remains poorbecause of dilating drops such as atropine, homatropine, cyclopentolate [Mydrilate],and tropicamide. By keeping your pupil dilated, your ophthalmologist aims tominimise the chances of long-term damage to the eye due to posteriorsynechiae. The drops also have the effect of lessening the pain in the eye.If rapid restoration of sight is very important to you, let yourophthalmologist know. It is possible to prescribe short-acting dilating drops tobe taken before bedtime. However, nobody knows whether this is more or lesslikely to lead to complications later. Most ophthalmologists would say thatafter two or three days of steroids and constant dilation, dilation at nightonly is safe.If anything, I have become more sensitive to light since treatment commencedThis is probably because you have been given dilating drops, which enlargethe pupil. This allows more light to enter the eye.Wear dark glasses.The doctor gave me an injection in the eye! Why is this necessary?In severe cases of iritis (uveitis), or when the iris is persistently stuck tothe lens, injections into the conjunctiva (the white part of the eye outside thecornea) are very effective in delivering a constant dose of steroids anddilating drops to the eye. The effect lasts for a day or two, and virtually allof my patients are glad that they opted to have it done, as the relief from painand discomfort is dramatic.The procedure sounds much worse than it is. The eye is thoroughly anaesthetizedwith drops before the procedure. There may be some dull pain after theprocedure and the eye may be difficult to close for an hour or so. Yourophthalmologist may advise padding the eye.The last time I had iritis (uveitis) my left eye was affected. This time myright eye is affected. My iritis (uveitis) must be getting worse as it has spread from oneeye to the otherThe majority of cases of iritis (uveitis) are relapsing and remitting, or in otherwords, it comes and goes. There seems to be little in which eye it affects. iritis (uveitis)going from one eye to another, with a quiet period in between, is normal.I have been given steroid tablets. What are the side effects?Steroid tablets (eg. Prednisolone) are given in cases of complicated uveitis,often posterior uveitis. They are used to dampen down the immune system.The major side effects are Weight gain in the abdominal area Purple lines on the abdomen and flanks Round ( moon ) face Increased susceptibility to infection Water retention Osteoporosis resulting in brittle bones Inappropriate hair growth (eg. facial hair in a woman) Baldness in men Acne Muscle wasting Hypertension (high blood pressure) Diabetes mellitusSteroids are given because your ophthalmologist judges that the risks to theeye outweigh these side effects. If your side effects are very severe, youshould discuss the pros and cons of steroids with your ophthalmologist.I seem to get an attack of iritis (uveitis) at least once a year. Is there anyway I can prevent the attacks from happening?I'm afraid not! There have been a few studies which suggest that stressis a factor. In earthquake victims living in tents in Japan, the rate of iritis (uveitis)tripled. There are scientific papers noting that flare-ups of rare kindsof iritis (uveitis) (JCA, Behçet, Vogt-Koyanagi-Harada) are less common during pregnancy.This is probably due to the change in hormones during pregnancy.I get attacks of iritis (uveitis) frequently. Do I need to see anophthalmologist at all? Can't my family physician prescribe theappropriate treatment?You need to see an ophthalmologist in order to confirm the diagnosis. If youhave only had iritis (uveitis) once or twice, you may be confusing the symptoms of someother eye condition with that iritis (uveitis).In particular, corneal ulcers may be mistaken for iritis (uveitis) by both patients andby non eye-trained doctors. This is an important distinction because cornealulcers are made worse by steroid drops.I keep an unopened bottles of steroid drops and dilating drops in therefrigerator at home in case I have flare-ups. Am I taking any risksself-medicating?If you have had iritis (uveitis) many times, you may come to recognise the symptomsaccurately. In an ideal world you would see an ophthalmologist to confirm thediagnosis as soon as you get the symptoms.In the real world, you may live 100 miles from the nearest ophthalmologist,or it may be 10 pm on a Saturday night and you may face a six-hour wait at thenearest hospital's casualty (emergency) department.If you do self-medicate in these circumstances, the risk you are taking issmall as long as you see an ophthalmologist the next day.I'm off to Antarctica for six months. I won't be able to consult anophthalmologist if I get an attack of iritis (uveitis). What can I do?This is a difficult question, and you alone must weigh up the benefits andrisks. I can only tell you what I would do if it was me myself who had to makethe decision.If I had very frequent attacks of iritis (uveitis) (more than one every six months)over the last few years, and there was a high probability of an attack while Iwas in Antarctica, I would probably not go.If attacks were rare (less than one a year), and each attack was not verysevere (not needing injections into the eye), and I was confident that I couldrecognise the symptoms of iritis (uveitis) accurately then I might well pack some unopenedsteroid and dilating drops. However, I would be aware that iritis (uveitis) is apotentially blinding condition and take that risk accordingly.What other conditions can cause symptoms of a painful red eye? Corneal ulcer -- in young people, often associated with contact lens wear.Treated with antibiotics/antiviral drops depending on the cause. Made worseby steroid drops. Corneal abrasions -- due to superficial scratches of the cornea (from directtrauma or from a foreign body in the eye). Very painful. May lead to cornealulcers if not treated with antibiotics as a precaution. Recurrent corneal erosions -- Very painful, recurrent red eyes due tounstable corneal epithelium (the surface covering of the cornea). Bacterial conjunctivitis -- causes a sticky red eye which is moreuncomfortable than painful. Often starts in one eye then spreads to the other.Treated with antibiotics. Allergic conjunctivitis -- causes itchy red eyes which are notparticularly painful. Usually affects both eyes. More common in people withmultiple allergies, with asthma, with hayfever, and with eczema (ie. with an atopicdisposition). Treated by drops which reduce the allergic response. Viral conjunctivitis -- causes a watery eye which is not usually verypainful. Often starts in one eye then spreads to the other. No effectivetreatment. May last for a long time (weeks to months). Chlamydial conjunctivitis -- causes a slightly sticky discomfort in both oneor both eyes which grumbles along for weeks before becoming significant enoughto see a doctor for. Usually sexually transmitted. Effectively treated withantibiotic tablets. Episcleritis -- reddening of part of the eye only. May be accompanied bypain, in which case steroid drops may help. Otherwise goes away by itself afterabout a month.

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