Uveitis, recurrent, acute

[sandy38]

I have now had 5 bouts of acute uveitis since the end of April, a little over a month.  Despite a course of oral prednisone, steroid drops X 3 per day and 1500mg of antivirals, I still got another attack last night.  Ironically, yesterday I had a followup with the doc and he lowered the drops and pills to twice a day because the eye looked perfect.  Why does this keep happening?  I have anterior uveitis which is the most common and I saw a cornea specialist who felt the uvetitis was likely caused by herpes simplex, thus the antivirals.  The funny thing is that it feels like it goes away in a day, or at least my vision comes back in a day.  I was tested last year for autoimmune issues and tested negative though I have had a high RF factor in the past. Any comments are appreciated about this frustrating condition!  My impression is that relapsing in such short time frames is very unusual.

[JohnHaganMD]

That many episodes of iritis indicate almost assuredly an underlying ocular or systemic disease. the most common cause of recurrent acute anterior iritis his HLA-B27 antigen positive. You should ask your ophthalmologist if you were tested for this and if not it needs to be drawn.  I would suggest you ask  your ophthalmologist for a referral to a "uveitis specialist" most large cities and university ophthalmology departments have one.  The positive rheumatoid factor may also be a factor.  It is unusual for herpes simplex to cause recurrent anterior chamber iritis. Much more likely to cause cornea disease such as cornea ulcers and cornea edema.

JCH MD

[sandy38]

Thanks so much for your comment.  I have had cornea edema, I believe that was the explanation why I virtually lose my sight in the affected eye.  Does that make a difference?

[JohnHaganMD]

Yes if you had corneal edema it could be a rarer form of herpes simplex uveitis with corneal involvement.  Still with the unsual persistance and reoccurance might want to progress to a uveitis specialist.

[sandy38]

Thanks Doctor.  I had a swollen cornea again today.  I'm seeing a uveitis specialist tomorrow who is with the Univ of Ca, Irvine Medical Center.  His name is  Sanjay Kedhar, M.D.  Thank you for your advice.

[JohnHaganMD]

Great place to go. Please post for readers what the diagnosis is. Thank you

[sandy38]

Dr. John,  The uveitis was clear today and that's one of the amazing things about this and that's that it clears so readily.  However, Dr. Kedhar said that I'm not getting recurrent uveitis, that it's just never gone away and it "flares up"  about every week.  Dr. Kedhar didn't have a firm opinion on herpes and discussed other etiologies with me and order blood tests plus a CT of my chest.  I have CVID and he felt that often correlates with sarcoid so he wants to rule that out as well.  So I have to have the blood work (including syphillis and the B27 test).  He said once they rule out other things then he'll go back to "the viruses".  When asked how I was still getting flare ups while on the antivirals, he said the dose may be too low for my body (or it's not a virus).  At some point they may take a tiny bit of fluid to search for viral DNA but that is way down the pike.  Thanks again.  If anyone ever gets uveitis I may be somewhat of an expert by then (lol) and can answer some questions.

[JohnHaganMD]

Best of luck. These are sometimes very complex work up and complicated treatment and having a uveitis specialist available is excellent. For many years I've used William Godfrey MD at U of Kansas Medical Center.