Patient's Query
Hello doctor,
Two years ago, I had an inflammation in my right eye. I went to an ophthalmologist who diagnosed me with anterior uveitis combined with a low IOP of 9 mmHg. He described eye drops Optired, five times a day for one week. Then the dose is reduced in the next two weeks until stopped. The effect of the eye drops usually takes place the next day of use, and the inflammation looks like nil. However, I kept following the described dose until the last day, when I had to do an eye IOP test to confirm no more inflammation activity.
My eye returns to normal, and pressure becomes 12 mmHg for three months, then the same inflammation starts to appear once again. The ophthalmologist recommended consulting an internist, who described a set of blood tests and an X-ray of the chest area. All are normal. Based on that, the ophthalmologist considered my case idiopathic. Since then, the symptoms appear every three months, and I do the same cycle of treatment. Sometimes only the Optired, else in conjunction with Plegica eye drops.
Recently, the ophthalmologist advised having a second opinion. Hence, I decided to write to an expert doctor trying to chase the physical reason that might cause the illness in my eye. I have done complete blood count (CBC), erythrocyte sedimentation rate (ESR), uric acid, hepatitis C virus (HCV), HIV, fasting blood glucose, SGPT (ALT), SGOT (AST), alkaline phosphatase, serum albumin, serum creatinine, serum urea, Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), CA 19-9, T3-total, T4-total, thyroid stimulating hormones (TSH), total serum cholesterol, Quantiferon T.B. Gold, prothrombin time (PT).
Kindly suggest.
Hello,
Welcome to icliniq.com.
I have gone through your blood reports (attachment removed to protect patient identity). They are quite extensive and have covered most of the routine uveitis workup. As your ophthalmologist has said, the majority of anterior uveitis cases are idiopathic and need to be treated as and when they flare up. Occasionally, if unresponsive to topical steroids, oral steroids might be indicated. We would refer you to an immunologist/ rheumatologist in these circumstances. The only specialized tests that I found missing are ANA (anti-nuclear antibody), ANCA (C and P) (anti-neutrophil cytoplasmic antibody), ACE (angiotensin-converting enzyme), Lysozyme, and HLA B27 (human leukocyte antigen).
If you have any history of joint pains, neck or back pain, dry eyes, or skin rash, an RA factor is required. Please note that these tests are a little expensive and might not really change the course of treatment. They are basically to rule out sarcoidosis (although your chest x-ray is normal) and other autoimmune activity that is causing the inflammation. Let me know if you decide to do these tests, if anything turns out abnormal. Or alternatively, meet an immunologist who will put you on the required immunosuppressive medication. Meanwhile, continue the Pred eye drops during flare-ups.
I hope this helps.
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Answered byDr. Asha Juliet Barboza
Medically reviewed byDr. Vinodhini J.
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