Dr. Asha Juliet Barboza
Ophthalmology (Eye Care)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Two years ago, I have an inflammation in my right eye. I went to an ophthalmologist who diagnosed as anterior uveitis combined to low IOP of 9 mmHg. He described an 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 inflammation looks like nil. However, I keep following the described dose until the last day where I had to do an eye IOP test to confirm no more inflammation activity. My eye return to normal and pressure becomes 12 mmHg for three months, then the same inflammation starts to appear once again. The ophthalmologist recommended to consult an internist who described set of blood tests and x-ray of the chest area. All are normal. Based on that, the ophthalmologist considered my case as idiopathic. Since that, the symptoms appear every three months and I do the same cycle of treatment. Sometimes only the Optired, sometimes else in conjunction to Plegica eye drops. Recently, the ophthalmologist advised to have a second opinion. Hence, I decided to write to an expert doctor trying to chase the physical reason that might bring the illness to my eye. I have done CBC, ESR, uric acid, 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, TSH, total serum cholesterol, Quantiferon T.B. Gold, prothrombin time (PT). Copy of all blood tests are available.
Hello,
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, majority of anterior uveitis cases are idiopathic and need to be treated as and when it flares 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 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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Ophthalmology (Eye Care)
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