Contact overuse, cronic iritis, photophobia, tearing, swelling, irritation

[jagibbs007]

I have had bouts of iritis i the past. I have worn contact lenses for years (a handfull of times this past year) and they have left me with corneal scaring and warped epitheleal tissue. For the past 6 months I've stumped the doctors. I have redness, tearing, swelling and irritation along with sivere photophobia. I have slightly cloudy vision on my cornea now, assuming this is white blood cells attacking an infection perhaps? No sign of cells with the staining uv light test.  As well as differences in color vision. One Dr. suggested this may be viral? Steroids and viagamox have helped in the past with the iritis, but these problems are returning and are persistant. Where should i go from here?

[indi1664]

Hi ..I hope your problem gets sorted out...but never make the mistake of wearing contacts too long...i did..for abt 10 -12 yrs (14hrs a day) eventually had blood vessel grwth which if not contrlled can lead to blindness..happy to say ..by going back to 8hrs /day ..the problem recedded and i am back to normal.

[John C Hagan III, MD, FACS, FAAO]

For comfort you can use the same treatment as for dry eyes which I will post below. If you feel you have an iritis (pain, sensitivity to light, soreness to touch, smokey vision) you should contact your current Eye MD as you may need dilation and steroids.  JCH III MD

DRY EYES


General Information on Dry Eyes

a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped

[jagibbs007]

I will seek the consult of a specialist on this.  I have gone to the garage, the lenses are gone, and rightfully so.  However, are there things i can do at home to manage symptoms and discomfort?  The irritation, tearing and photophobia have become overwhelming, and are interfearing with my life to the point where some days I can not even drive my car.  

[John C Hagan III, MD, FACS, FAAO]

Well, first I would go to the garage and throw away the contact lens. Period.

Warped corneal epithelial cells will blur your vision so blurred vision is no mystery.

Iritis is another issue and often the cause cannot be found.

At some time you should be evaluated by a rheumatologist and either a uveitis specialist or corneal specialist.

JCH III MD