Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Iritis

Hello,
I used to post quite regularly - but since the LSD has kept my AS symtoms very mild and most of the time non-existant, I can almost forget I have it. However, just the other day, the iritis which I have not had for 5 years returned. Iritis was actually the thing I had a year before the AS symptoms (saccroilliac pains) started, and it was the thing that alerted the doctors to having me tested for HLA B27 (I am positive). So actually the iritis occurred one year before my very first AS symptoms. I had thought, up till 3 days ago, that iritis would not return - but out of the blue it came back. I have a feeling that it could have been related to something I did, since it seems to have occured without any AS symptoms - making me think that perhaps it is not controlled by the NSD. Does anyone know whether the NSD / LSD has any impact on iritis? Also, regarding treatment for iritis - the doctor has prescribed steroid drops (prednisolone): first day a drop every hour, second day every two hours, third day every three hours, fourth day 4 times a day until I see the doctor in 3-4 days time again. The strange thing was that immediately I noticed the familiar iritis signs, I rushed to the eye hospital where they checked the eye with the usual microscopes etc. However, although they said it could be iritis, they felt that the signs of inflammation were not really present. They siad it could be too early to tell. This happened the next day too. then on the third day, as I was still experiencing pain and light sensitivity, I went to a consultant at a private hospital. He immediately found the signs of inflammation and put me on the drops. This has left me feeling slightly insecure about going to the eye hospital again - since I feel that this could have been treated 2 days earlier. Perhaps they simply were not expert enough to see the presence of iritis at an early stage? Has anyone else experienced this....
It is now saturday morning, and I started the treatment on Wednesday. Certainly, the inflammation has almost gone and the eye is not painful - though there is still some halo present when I look at light. It this normal? Can I still expect to have some symtoms after 3 days of treatment? Does anyone have any alternative ideas as to how to combatt iritis? Since I was able to control the AS pains through the LSD, I would love to find some way of controlling the iritis too - as I don't like the idea of using steroids - especially if the iritis comes back.
I asked the consultant if he knew of anything that could have brought on the attack of iritis. He said that there is a possibility that some kind of physical stress / exertion / change of temperature-climate could have triggered it? This is interesting, as the very day before the attack, I had done a strenuous run at the gym for half an hour (something I had not done for ages - it was a concerted attempt to try to get fit!!). Also, I had got rather cold - when I left the warm gym very sweaty after the run, and went out into the cold air whithout changing. Stupid I know, but I thought I was tough! So - this seems to tally with what the consultant said.
If iritis is also related to the gut, like AS, once again - just a week ago I had a slight stomch upset due to eating large quantities of seafood in Spain. Again, could this have compromised my gut lining - this beinging on the iritis attack?
Someone on another site said that whenever he feels iritis symptoms coming on, he washes his eyes in cold water, and the symptoms go away. Has anyone any idea about this? Perhaps, something getting into the eye - a foreign body or grit - can bring on iritis?
One final quation. Has anyone any alternative treatment ideas: eg Bilberry extracts?
Looking forward to hearing from you!
Best wishes
Chris (iffot)

I know how you must feel . A regular er doc or even my glasses doc could not tell what it was had to go to an opthamologist and he put me on steroids which made me so sick I could not go on with it but the acular drops are ok. I have not found anything that has brought back my sight completely in the right eye since then which would be December . I know I cannot take meds like Enbrel and NSD etc. have reacted to them so I do get the halo effect often and I have a sun looking thing in the middle sometimes was told white blood cells I was diagnosed with uvietis and iritis and he said most likely due to AS but I have some strange things going on too behind the eye, most of what is our problem he said is the inflammation on the nerve and then that causes fuzzy stuff and pain to happen. Good luck sorry I did not have anything that works for me but I do use a magnifying glass cause i love to read and I can still read the eye chart through the spots and all it is a very tricky problem to go through. Take care and you are being thought about and prayed for. Peace and love to you and yours. sbcook2

Hi, I'm no expert other than that I've had this condition 5 times in the last 15 months and ask a lot of ?'s and read a lot on the topic. What I've learned so far is that iritis is an auto-immune disease, where our WBC's attack our own tissue. Iris tissue is similar to that which AS attacks in our spines from what I've read (lost links due to recent computer maintenance). Iritis is diagnosed by the Dr. observing WBC's in the eye chamber through a Slit Lamp. Symptoms include red eye, pain, fixing of the pupil a result of iris swelling resulting in photo-sensitivity. Did none of the doctors at the eye hospital check your eye with a Slit Lamp?

The first time I had iritis, my optometrist obs. cells in my anterior chamber and sent me off to see the on-call ophthalmologist at the hospital-stat. This occurred the day before we left for 2 week vacation in Florida, and it took several calls to pharmacy's to find one with all the meds I needed.

My recent episode this March presented with redness and pain, no light sens. or fixing of pupil. Iritis was quite aggressive since I had left it a few days. I've had occ. eye pain since I first dev. iritis Oct. 2003, and went for eye exam one time due to this-no iritis. I resolved not to go unless light sens. or "fixing" present, but after a week on and off redness and soreness, thought I'd get it checked out. There were so many cells present, I was on eye drops hourly for a week, plus Maxidex at bedtime. Finally off drugs and eye is clear now. From this I've learned that iritis may not present with the usual symptoms and it's better to visit the Doc. than wait it out too long. I suppose the lack of light sens. may be due to the use of Naproxen for inflammation of SI joints, perhaps easing some of the infl. of the iris? Dr. not sure either, but he could see the swelling of my iris right away in the dim light of his operatory. Fortunately I didn't need the dilation drops this time-it's very hard to work at a computer with dilated pupils-the screen light drives you crazy (sunglasses-but while at the office too many questions from our patients-I work in a dental office part-time).

My vision has not been affected by iritis, but I still get pain in my left eye from time to time. Does anybody else get random pains in their eyes? Is there a co-relation to a flare with iritis in conjunction with AS flare?

I'm still in denial that I may have AS. The rheumy says quite likely, and I'll know better later this month after we've reviewed the MRI results. X-rays of SI joints reveal Sacroiliitis, CT scan sugg. Osteitis Condensans Ilii, a condition suffered by women with multiple births (I've never been pregnant)-doc thinks this Dx a result of radiologist inexperience. Any way, still hoping it's something other than AS-I'll keep you posted when I know.

Hi Chris

When I get iritis, once every year or so, it's usually very mild. Since I'm used to getting iritis I've learned to recognize the symptoms very early, so when I see the ophthalmologist he or she can't see the telltale signs of the iritis. But because of my history with iritis and AS, and the the other symptoms (irritation, sensitive to light, though without actual pain, red eye) they always treat it as a iritis and prescribe steroid and dialating drops. So I believe it is a matter of the ophthalmologist having the experience enough with iritis to trust the patient's description of the symptoms and draw the correct conclusions without enough clinical data.

Can't help you with the LSD/NSD part.

regards

/Mattias

Hi,
I think when we have AS we need to learn the position of our bodies and be always aware of what our bodies is telling us.
I know all about Iritis. And I know in my case the major culprit that will bring it on is STRESS. But I have learned to keep a supply of predislone on hand. The only time I will see the doctor is if I am out of it and need a new perscription. I have a supply in my refridgerator right now. First thing I do is to be aware that I am worried about something. Quit it and start the treatment like you said in your posts and in about 4 days or so I am just fine.
Why give my money to the doctor when I could use it to go shopping.

I would think the situation at the Gym caused your body to be shocked and stressed by the cold. If you run at the gym for half hour you need to stretch and cool down and put on warm clothes before you go outside.
With AS our bodies are a little fragile.

Hope you are feeling better real soon.

Doreen

Hi Chris,

I have problems with episcleritis, which is similar. There has been somewhat of a pattern to mine at times, but it pretty much goes wild when it chooses to. I've tried steroid drops, taking prednisone, motrin, and the list goes on. Nothing helps it as far as getting rid of it faster for me. It always lasts 3-4 days. The most effective so far has been the medication I have for migraines because it takes most of the pain away from the extremely bad headaches it gives me. Even when I was having no pain from AS it still happened. It hits me at least once every 2 months.

My eye doctor insists it's allergies because I have a long history of allergy problems. I can't go to the specialist every time it happens because by the time I get an appointment it will be gone, so I don't even bother with the eye doc anymore. It's really hard to try to have something treated when it seems as though a lot of people just plain don't understand it.

Good luck to you

Amanda

Hi Chris,

I cannot help answer whether or not the LSD may have been responsible for keeping your iritis from returning for 5 years, (although we have other members who report similar success) and in my opinion, anything that seems to aid in preventing attacks might be worth continuing with.

From past reading I've learned that many people diagnosed with AS have had an Iritis attack as the first sign/symptom of the onset of AS, so you are not alone this experience. I've had iritis attacks when I'm not flaring any worse than usual, and so I've also recognised the two do not always coincide.

Once you've had a few attacks, it's actually quite common for patients to detect the initial stirrings of an attack long before the Ophthalmologist is able to see it with slit lamp test. I've been able to sense an oncoming attack as early as 1.5 weeks before my eye doc could confirm the problem. This is actually good news for you, since you are better able to get timely treatment, or can practically avoid it altogether by treating it at the earliest possible sign. The only trouble is convincing your eye doc, and trusting your instincts enough to go back in to the doc a few days after they've insisted you are fine. Eventually, the doc will recognise your keen awareness and begin to trust your judgement. Please do not feel insecure about your ability to judge this - the fact you were right should boost your confidence!!! Your persistence to have yourself re-checked was very wise! It's possible they may have failed to recognise/diagnose the attack, but in your case I think that it's unlikely. They mentioned it may have been too early to tell, which suggests to me that this eye clinic is very competent and that you were in good hands.

I also believe (from personal experience) that physical (and even emotional?) stress / exertion can be one of the factors which makes us more prone to having an attack of iritis.

Hope you continue to improve, and that iritis will stay away for a long long while.

Hi Sigrid, and Welcome to KA (from a fellow Ontarian)!

The fact you've suffered from 5 attacks in 15 months might mean your iritis is turning chronic and you may need to consider a low maintenance dose of steroid drops to prevent bigger attacks. If your Ophthalmologist doesn't have a lot of experience treating iritis, you might ask if they could recommend someones who does. An experienced Ophthalmologist would likely caution you that iritis symptoms can vary tremendously and it will not always present with redness, pain, or light sensitivity. I've had fairly bad attacks where none of the top 3 clues were present. The sensation of dust in the eye, and once just slight double vision by itself was enough to make me realise that something was wrong. You should make sure to have your eyes checked whenever anything odd seems to show up.

Unfortunately, it does sound very likely that you do have AS (or one of it's closest relatives). Iritis and sacroilitis are fairly big indicators.

Glad you have found KickAS!

Hi Amanda,

I don't have any personal experience with episcleritis, and so your post stirred up my curiosity.

I found this info: from the Ocular Immunology and Uveitis Foundation site
The Severity of Episcleritis and Systemic Disease Association

Two of the postdoctoral ocular immunology fellows , along with a biostatistician have analyzed the records of 100 patients (138 eyes) with episcleritis evaluated by us over the past decade or more. Data were extracted from the medical records and placed into a customized database software package to determine the frequency and type of systemic disease eventually discovered to be associated with each type diffuse vs. nodular of episcleritis.

The mean age at presentation to our service was 43 years (range 18-76), with females predominating (female/male = 7/3). One-third of the patients had bilateral involvement. 16% had nodular episcleritis, and in 28% of the patients the episcleritis was recurrent. Associated systemic disease was found in 1/3 of the patients (36%). One-half of the patients had concurrent other ocular involvement, including uveitis (13%), glaucoma (5%), and keratitis (13%). In only 4 did the episcleritis progress to true scleritis. The most serious systemic disease discovered in the course of investigating these 100 patients was in a single patient with episcleritis who was discovered to have Wegener’s granulomatosis.

Most patients required no treatment except "supportive" care with iced artificial tears, but some have had at least a short course of oral nonsteroidal anti-inflammatory drug therapy (often non-prescription strength).

Conclusions: Although episcleritis is typically a benign and self-limited disease and therefore does not need topical steroid therapy, some patients do require treatment and we believe that the appropriate treatment is with low-dose oral nonsteroidal anti-inflammatory drug therapy. Additionally, since 1/3 of the patients may have associated occult systemic disease, an extremely careful review of systems history taking is appropriate, with appropriate laboratory testing based on the pertinent positives emerging from that survey.

And this: from the same source, but under the heading of Inflammation
Inflammation is a characteristic reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain. When immune system cells and molecules invade tissues and organs as part of an immune system response, the collection of immune system cells and molecules at a target site is broadly referred to as inflammation.

Inflammation is a protective response. The ultimate goal of inflammation is to rid the individual of both the initial cause of cell injury (e.g., microbes and toxins) and the consequences of such injury, the necrotic cells and tissues. Inflammation and repair are closely intertwined. However, both inflammation and repair may be potentially harmful, as is commonly seen in allergic and autoimmune diseases. Components of both innate (essentially neutrophiles, other ganulocytes, macrophanges, and the complement system) and specific immunity (B and T lymphocytes through their antibodies and cytokines) may not only damage inflamed target issues but also may participate in the "innocent bystander injury" of surrounding normal tissues. So this sounds like allergies can be responsible for eye inflammation, but I guess that wouldn't mean it's any less harmful.

Since you're experiencing such frequent problems, maybe printing this out might help you instigate a good conversation with your regular eye doc to request whether further investigation by a specialist is warranted?

Take care, and good luck with this!

Hi Doreen,

I've noticed the stress connection too, and agree that controlling it can be helpful in reducing iritis flares.

I would however, advise against self-treatment since iritis is a sight-threatening condition , and it is highly dangerous to assume it can be treated in the absence of professional care.

Many of us suffer from attacks that are far too severe and unpredictable to be managed without being under an Ophthalmologist's guidance (at the first available appt), or to know with any degree of certainty the correct dosage relative to the amount of inflammation once an attack has hit. Nor are we capable of detecting the increased ocular pressure that may result.

Doreen, I think you are very fortunate to have escaped harm all these years. I can only guess that you are very tuned-in to yourself and your unique history of attacks to manage self-detection/ treatment as well as you have. Possibly you suffer minor attacks and catch them so early that you're safe to continue, but anyone else would be ill-advised to follow your path and expect the same luck and good results.

Money given to a doctor to save one's eyesight is money well spent, in my opinion.

Happy shopping to you though, Doreen!