Hello, my name is Scott. In early 1998 I awoke for work one morning and noticed redness and irritation in the right eye. I believed it may have been merely sleep irritation or soap from the shower so I treated the eye with common Visine from the local Grocery store. After an entire afternoon and then being fired from my position with a bank that very afternoon I noticed that the condition was actually getting worse. Worried, frustrated with the bank, and upset I called my primary care doctors office and was given a late afternoon appointment. My primary care doctor diagnosed it as pink eye and gave me a prescription for drops for pink eye and told me not to touch anyone if I had touched the eye. Later that evening while sleeping, I awoke only to some of the most severe pain in my right eye that I could have imagined. I couldn’t even look at the digital alarm clock without having close the eye in great pain. I called the on call doctor at my primary care offices and was told to go the local emergency room to have it checked for excess pressure. Once at the emergency room it was difficult to sit in triage as the lights were excruciatingly painful. I wore a towel over my head to keep the eye in the dark. Once I was seen by a doctor he of course wanted to take a look inside…………….bad idea since the adhesions to the iris and lens had formed and were the cause of the pain. Once he opened up the shutter on his eye camera I passed out due to the immense pain. I awoke to find myself on a litter with an IV being threaded into my left arm and the doctor asking if I had any heart problems or history of heart attack. At this point my heart rate was only about 40 bpm. This was obviously due to the body’s reaction to the immense pain from the light that was shined into my eye. I was treated with some narcotic pain meds for the pain, and some dilating solution and told to see an ophthalmologist most hast. After visiting my eye doctor we did a multitude of blood work, and a chest x-ray. Every thing was negative except one little thing. I have contracted genital herpes without any symptoms. After an injection, months of steroid drops and dilating drops I was finally given the go ahead to seek out a doctor that specialized in eye disease. I finally got in to see him and he started me on oral prednisone. I was taking 4 pills every morning, dropping the eye with both pred-forte and dilating drops and finally after about 3 months the eye was back to normal. That was 1998, it is now 2007 and I have the exact same sequence of events taking place. I have had one injection and the usual drops. At one point after the injection it was seemingly starting to show improvement in both reduced inflammation and redness and the improvement in sight. However, the last couple of day’s the eye has seemingly had a reversal of good fortune. I am noticing that the adhesions are back onto the iris and lens and the pain is starting to come back unless I dilate the eye heavily and get the iris to open up a bit. This is sooo frustrating since I’ve been down this road before. I cant see, I cant go outside, and I’m isolated in my home due to the bright light of the sun and anything other than a dark room with a bit of television. I’ve had to drop out of my college classes due to the inability to see and read and my future with this eye as it is looks very dim. No pun intended. I am scheduled to see another specialist, but not for another month. I am also trying desperately to get in to see a specialist in rheumatology since my autoimmune disease marker, ANA test, came back positive as well. I pray the right doctors and right courses of action will help to get this eye normal again, but I’m afraid that the long session of the inflammation has left me with less than normal eye sight.
Scott — “I’m ridin, I’m shinin up my saddle” Aerosmith “Back in the Saddle”
Editorial Comment – Scott would best be served by having a definitive diagnosis as to what is causing the uveitis. Herpes related uveitis can typically be treated with antiviral medication as well as other medications during an acute phase and then, taken once a day as a prophylaxis to prevent recurrence. Autoimmune related uveitis is treated with the stepladder approach to care, hyperlink insert, and may need immunomodulator chemotherapy. A uveitis specialist is quite experienced in differentiating between the two types of causes through certain characteristics on exam. F. Foster USG Chair/facilitator
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Uveitis and Steroid-Sparing Therapy
Presented by C. Stephen Foster, MD, FACS, FACR
Audio-Digest Ophthalmology Volume 56, Issue 15