I have just been told I have the following eye problems, now what?T?

Question

Today the optometrist told me I have iritis, corneal edema, and adies tonic pupil. He gave me some steroid drops and set up an appointment with an opthamologist. What further treatment should I expect? How long for recovery? Will I recover? I am also concerned about possible issues of root causes such as autoimmune diseases. Is it possible that I may have some type of autoimmune disease?

Answer 1

I have suffered from recurring bouts of iritis for the past 14 years. It is very annoying and, in my case, it is idiopathic, i.e. no underlying cause. Always in my left eye. I do know that it is an autoimmune syndrome and I find that it generally recurs after my  immune system has been compromised in some way, e.g. after a bad cold, bad hay fever, if I'm run down or stressed. The usual treatment consists of steroid drops (Predforte) for a number of weeks. I can recognise the signs very early on so I go to the opthalmologist asap. Never wait - if you delay the pain increases tenfold, it takes much longer to recover and you might even have to go on cortisone tablet (never a good thing) or even...worst of all, the dreaded injection in the eyeball. As for autoimmune diseases, there are a number of blood tests and other tests that can be done to find out if you have an underlying problem. Good luck!

Answer 2

Steroids, and drops to dilate the pupil if there is any suggestion of the iris adhering to the front of the lens (Synechiae=> risk of acute glaucoma),  are the standard treatment.

Resolution can be anything from a few days to a few months, but if there is significant corneal oedema, without seeing you, I'd expect the longer course.

Recovery:  I've seen people who have had multiple episodes of iritis and I would not have known had they not told me.  Others where, while the vision was not impaired, residual traces could be detected on examination with a consulting-room microscope.  Recovery to that level is usual, but cannot be guaranteed.  

Sometimes the pupil is distorted and, or, poorly or non-reactive to light.  

Significant loss of vision is rare but I can't say it's impossible.  Secondary acute glaucoma, and inflammation spreading to the inner uveal tissues (choroiditis) are the main concerns.

Apart from a confirmation of the diagnosis, as you are aware the principle issue is whether this is associated with any underlying condition such as rheumatoid arthritis or lupus.  Such will certainly be tested for.

In about 50% of cases there is no link, and the iritis is idiopathic: a useful medical term meaning "It just happens, we don't know why."

There, while there is some risk of repeated attacks,  knowing the symptoms lets the person report quickly for treatment.  No clear preventative measures have been established except that stress and fatigue do appear to be, to some extent, precipitating factors.  

Best wishes, Optometrist, retired.