Any info on uveitis?

My mother has got uveitis (she's had lyme disease for nearly 30 years) and her doctor has given her steriod eye drops.
She says it is less painful but she still can hardly see anything in the worst affected eye. She's been using the steriod drops for several weeks and is tapering off, so she has almost finished the treatment.

The doc said, if this doesn't clear it up, he'll try giving her oral steriods.

I'm obviously worried about the other damaging effects steroids could give her, does anyone have any advice gien them by a lyme doc on this?

My mother doesn't have a lyme doc and is not on abx BTW. She has had such bad herx reaction from abx every time she tried them that she doesn't want to try.

[JackieCalifornia]

Just found this online, doesn't seem to have a political axe to grind either for or against Lyme; takes a neutral point of view.  This is part of a longer article.  I searched "lyme uveitis" and got this and other articles that may be helpful.  This part of a much longer article.

------------------------------------------------------------------------------------
[As usual, take out all the space and deleted the square brackets]

http: // emedicine. medscape. [com] / article / 1202521 - overview#a30
------------------------------------------------------------------------------------


"Ophthalmic Aspects of Lyme Disease Overview of Lyme Disease"

    Author: Gerald W Zaidman, MD; Chief Editor: Hampton Roy Sr, MD

=== Treatment of Lyme Disease ===

Difficulties can arise in choosing the appropriate antibiotic treatment regimen, especially in children or potentially pregnant women. Again, an infectious disease consult is helpful in these situations. Finally, if one decides to become actively involved in the management of these patients, stay abreast of the literature, especially in the rapidly changing areas of diagnosis and treatment.[14]

Stage 1 treatment

All patients with stage 1 Lyme disease should be treated with any one of the following oral antibiotics for 2-3 weeks: tetracycline, 500 mg 4 times a day; doxycycline, 100 mg 2 times a day; phenoxymethyl penicillin, 500 mg 4 times a day; or amoxicillin, 500 mg 3-4 times a day.

Children, pregnant women, patients who cannot tolerate tetracycline, and patients who are allergic to penicillin may be given erythromycin, 500 mg 4 times a day.

Later-stage treatment

Patients in the later stages of Lyme disease can be treated with oral antibiotics, but these patients usually need 30 days of therapy. Patients with severe disease (eg, meningitis, neuroborreliosis, carditis) require parenteral therapy with beta-lactam antibiotics, such as 14-21 days of one of the following: intravenous penicillin G, 3-4 million units every 4 hours; intravenous ceftriaxone, 2 g/d in divided doses; parenteral penicillin and ceftriaxone in combination; or roxithromycin and cotrimoxazole in combination.

Combination therapy may be worthwhile in patients who do not respond to monotherapy. Physicians should observe patients closely for possible Jarisch-Herxheimer reactions after the institution of therapy; this allergic/inflammatory response may manifest in the skin, mucous membranes, viscera, or nervous system.

Other treatments

Stage 1 conjunctivitis and photophobia require no therapy. Stage 2 Bell palsy is self-limited but requires supportive therapy to prevent the complications of exposure keratitis. Keratitis and episcleritis benefit from topical corticosteroids, usually a short course of prednisolone acetate 1% or fluorometholone 0.1%.

A treatment regimen for severe neuro-ophthalmic disease (involving the optic nerve) or posterior segment disease (eg, pars planitis, vitreitis) has not been established. Oral corticosteroids without concomitant antibiotics should not be used. The best approach for these patients might be a therapeutic antibiotic trial, in which patients can receive 2-3 weeks of intravenous penicillin or ceftriaxone. If patients respond to treatment, the trial is successful, ocular Lyme disease is diagnosed, and no further therapy is needed. Recurrences of Lyme uveitis, once adequate intravenous therapy has been given, can be treated with judicious corticosteroids.
------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------
Now, how one defines 'judicious corticosteroids' is a good question.  You might quiz the doctors about their familiarity with Lyme, to be certain you are dealing with a doc who understands the potential countervailing effects of treating vs not treating and Lyme v uveitis in your mother's particular case.  It's a conversation I would think worth having, in my nonmedical opinion, so that you are fully informed.

Best wishes -- thinking of you and yours --

[mojogal]

Sorry, I never heard of it but if she does still have Lyme steroids could be a problem.

I tell this story, not to upset people but to inform them , that after taking steroids, I wound up in the hospital on a respirator.

I don't think drops would be as bad but not sure. Maybe someone else has more info.

I wish her good luck.

[JackieCalifornia]

Is she in the UK?  It might be a different treatment standard from the US ... or the doc is just clueless.  A few years ago when I was in or about done with treatment for Lyme, I went to my ophthalmologist for a regular check up, and when he asked about my health generally, I apologetically told him I had Lyme and babs.  I felt myself going into a defensive crouch, figuring the ophth was going to go all nuts about Lyme quacks etc., and I just wasn't up for dealing with it.  

But no, he did quite the opposite!   Apparently ophthalmologists take Lyme VERY seriously, at least in my corner of the US.  So maybe a second opinion is in order before taking steroids -- because would be very concerned about the side effects as well.

You could try reading up on the issue online, and see what the ophthalomology journals and organizations say.  

I just looked at medicinenet ******* and found this:

----------------------------------------------------
What is the treatment for uveitis?

Because uveitis is an inflammatory condition, the urgent treatment centers on control of the inflammation. This can be achieved with steroids given as eye drops, injection in or around the eye, orally (by mouth), or intravenously, depending on the extent and severity of the inflammation.

In certain situations, alternatives to steroids (such as indomethacin, methotrexate, and others) may be used.

The duration of the treatment may be as short as a week or several months or even years, depending on the cause.

If the cause is infectious, an anti-infective medication will also be used (for example antibiotic, antiviral, or antifungal) to combat the underlying infectious agent.
-----------------------------------------------------------------------

So it sounds like the doc has assumed the cause is autoimmune rather than bacterial ... but it's a conversation worth having about trying to treat without steroids.  

[JackieCalifornia]

oops, forgot the square brackets:

medicinenet [dot] com

on the topic of uveitis

[youvegottobekidding]

Thanks for the suggestions Jackie!
I read up and found teh same thing, basically, you need abx as well as steroids to get it under control. It seems even lyme docs resort to steroids in this case as the alternative is going blind.
My Mum has been given steroids before and she was OK on them so, I don't feel too happy about her taking them but I guess it's the lesser of 2 evils.

[JackieCalifornia]

If there is any difference between oral admininstration and eyedrops to what extent the steroids reach the rest of the body, and if the eyedrops are as effective (or as nearly effective) as oral, then I would perhaps choose the eyedrops.  Might be worth asking about.

[JackieCalifornia]

Just found this online, doesn't seem to have a political axe to grind either for or against Lyme; takes a neutral point of view.  This is part of a longer article.  I searched "lyme uveitis" and got this and other articles that may be helpful.  This part of a much longer article.

------------------------------------------------------------------------------------
[As usual, take out all the space and deleted the square brackets]

http: // emedicine. medscape. [com] / article / 1202521 - overview#a30
------------------------------------------------------------------------------------


"Ophthalmic Aspects of Lyme Disease Overview of Lyme Disease"

    Author: Gerald W Zaidman, MD; Chief Editor: Hampton Roy Sr, MD

=== Treatment of Lyme Disease ===

Difficulties can arise in choosing the appropriate antibiotic treatment regimen, especially in children or potentially pregnant women. Again, an infectious disease consult is helpful in these situations. Finally, if one decides to become actively involved in the management of these patients, stay abreast of the literature, especially in the rapidly changing areas of diagnosis and treatment.[14]

Stage 1 treatment

All patients with stage 1 Lyme disease should be treated with any one of the following oral antibiotics for 2-3 weeks: tetracycline, 500 mg 4 times a day; doxycycline, 100 mg 2 times a day; phenoxymethyl penicillin, 500 mg 4 times a day; or amoxicillin, 500 mg 3-4 times a day.

Children, pregnant women, patients who cannot tolerate tetracycline, and patients who are allergic to penicillin may be given erythromycin, 500 mg 4 times a day.

Later-stage treatment

Patients in the later stages of Lyme disease can be treated with oral antibiotics, but these patients usually need 30 days of therapy. Patients with severe disease (eg, meningitis, neuroborreliosis, carditis) require parenteral therapy with beta-lactam antibiotics, such as 14-21 days of one of the following: intravenous penicillin G, 3-4 million units every 4 hours; intravenous ceftriaxone, 2 g/d in divided doses; parenteral penicillin and ceftriaxone in combination; or roxithromycin and cotrimoxazole in combination.

Combination therapy may be worthwhile in patients who do not respond to monotherapy. Physicians should observe patients closely for possible Jarisch-Herxheimer reactions after the institution of therapy; this allergic/inflammatory response may manifest in the skin, mucous membranes, viscera, or nervous system.

Other treatments

Stage 1 conjunctivitis and photophobia require no therapy. Stage 2 Bell palsy is self-limited but requires supportive therapy to prevent the complications of exposure keratitis. Keratitis and episcleritis benefit from topical corticosteroids, usually a short course of prednisolone acetate 1% or fluorometholone 0.1%.

A treatment regimen for severe neuro-ophthalmic disease (involving the optic nerve) or posterior segment disease (eg, pars planitis, vitreitis) has not been established. Oral corticosteroids without concomitant antibiotics should not be used. The best approach for these patients might be a therapeutic antibiotic trial, in which patients can receive 2-3 weeks of intravenous penicillin or ceftriaxone. If patients respond to treatment, the trial is successful, ocular Lyme disease is diagnosed, and no further therapy is needed. Recurrences of Lyme uveitis, once adequate intravenous therapy has been given, can be treated with judicious corticosteroids.
------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------
Now, how one defines 'judicious corticosteroids' is a good question.  You might quiz the doctors about their familiarity with Lyme, to be certain you are dealing with a doc who understands the potential countervailing effects of treating vs not treating and Lyme v uveitis in your mother's particular case.  It's a conversation I would think worth having, in my nonmedical opinion, so that you are fully informed.

Best wishes -- thinking of you and yours --

[youvegottobekidding]

Jackie you're a star, thank you so much for that!
I've emailed it to my sister and my Mum is going to take a printout to the doc tomorrrow to ask for one of the abx listed. She's able to tolerate penicillin and amoxycillin so hopefully she'll be OK with one of those.
THANK YOU!!!!