Managing Uveitis: Treatment, Complications, and Cataract Concerns

Q: Managing Uveitis: Treatment, Complications, and Cataract Concerns

Hello Qianqian： When iritis is mild, there are usually no significant symptoms. <br>However, when it becomes severe, it can lead to acute glaucoma, causing pain and blurred vision. <br>Cataracts are also a common complication of recurrent iritis that is difficult to avoid. <br>Ir

Treatment and Complications (Sequelae) of Iritis

Hello Doctor, I have experienced iritis four times this year, approximately once a year, with each episode occurring during the transition from summer to autumn.
Since the first episode, the doctor at the clinic requested blood tests at a major hospital, which revealed that I have the HLA-B27 gene.
Subsequently, the doctor treated me with eye drops and oral corticosteroids, which resulted in a good recovery.
This year, due to being away from my hometown, I quickly went to the local teaching hospital's emergency department on the night of the flare-up and explained about the HLA-B27 gene.
The emergency doctor only prescribed acetaminophen.
Two days later, the outpatient doctor informed me that I had toxoplasmosis and prescribed medications including a dilating agent, eye drops, ointment, intravitreal injection, and antibiotics.
When I requested oral corticosteroids, the doctor stated that I needed to wait for the CDC to provide the medication.
Four days later, I suddenly experienced complete fogging in one eye, as if I had just come out of an air-conditioned room.
That day, the emergency department only provided a suspension corticosteroid eye drop.
Two days later, the outpatient treatment was similar to the previous visit, with an additional 20 mg/day of corticosteroids, but the CDC medication had not yet been provided.
After seven days, the outpatient clinic finally provided the medication, except for the injection, and the CDC medication finally arrived.
However, after about two weeks of treatment, I changed medical facilities due to the distance, and my iritis quickly improved, but the doctor mentioned that I have early-onset cataracts.
In the past, my iritis episodes lasted about ten days without redness, pain, or blurriness.
Is the cataract this time due to the prolonged treatment? Is corticosteroid medication the first choice for iritis caused by HLA-B27? Does iritis always lead to cataracts? Recently, I have been troubled by blurred vision and am unsure if I should consider changing to an artificial lens, as I am only 35 years old.
What should I do?

Qianqian, 30~39 year old female. Ask Date: 2020/10/01

Dr. Gao Pilin reply Ophthalmology

Hello Qianqian: When iritis is mild, there are usually no significant symptoms.
However, when it becomes severe, it can lead to acute glaucoma, causing pain and blurred vision.
Cataracts are also a common complication of recurrent iritis that is difficult to avoid.
Iritis associated with HLA-B27 is often severe and requires the use of corticosteroids.
Recurrent episodes can lead to cataracts.
If there was a pre-existing cataract, it may not affect vision until it reaches a certain level of opacity.
If vision is affected, surgery may be necessary, but it should be evaluated by a physician for feasibility.
For reference, you can check https://bit.ly/2Sg3z6L and https://bit.ly/3l4Faxr.
The ophthalmology department at Puzi Hospital in Taiwan is available on Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM, and Wednesday afternoons from 2:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is essential to seek medical attention at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Gao Pilin

Reply Date: 2020/10/01

More Info

Managing uveitis, particularly in the context of recurrent iritis (or anterior uveitis), can be quite complex, especially when associated with conditions like HLA-B27 positivity. Your experience with multiple episodes of iritis and the subsequent complications, including the development of early cataracts, raises several important points regarding treatment, potential complications, and the long-term management of your condition.

Treatment of Uveitis
The primary treatment for uveitis typically involves the use of corticosteroids, which can be administered topically (eye drops), systemically (oral medications), or via injection. In your case, it seems that corticosteroids were initially effective in managing your symptoms. However, the delay in receiving appropriate treatment during your recent episode, particularly the reliance on over-the-counter pain relief (like acetaminophen) instead of corticosteroids, may have contributed to the worsening of your condition.

Corticosteroids are indeed the first-line treatment for uveitis associated with HLA-B27, as they help reduce inflammation and prevent complications. It’s crucial to initiate treatment promptly to minimize the risk of complications, including cataract formation and glaucoma.

Complications of Uveitis
One of the significant complications of chronic or recurrent uveitis is the development of cataracts. The inflammation itself, along with the prolonged use of corticosteroids, can lead to cataract formation. In your case, the early onset of cataracts at the age of 35 is concerning, especially since you have experienced multiple episodes of iritis. While not every case of uveitis will lead to cataracts, the risk increases with the frequency and severity of the inflammation, as well as the duration of corticosteroid therapy.

Cataract Concerns
The development of cataracts can significantly affect your vision, leading to symptoms such as blurriness, glare, and difficulty seeing in low light. Given your age and the impact on your quality of life, it is reasonable to consider cataract surgery if your vision is significantly impaired. Modern cataract surgery is generally safe and effective, and many patients experience a substantial improvement in their vision post-surgery.

Long-term Management
Managing uveitis effectively requires a comprehensive approach. Regular follow-ups with an ophthalmologist who specializes in uveitis or inflammatory eye diseases are essential. They can monitor your condition, adjust your treatment plan as necessary, and provide guidance on managing any complications that arise.

In addition to corticosteroids, your doctor may consider other immunosuppressive therapies if your uveitis is recurrent and difficult to control. These medications can help reduce the frequency of flare-ups and minimize the need for corticosteroids, potentially reducing the risk of cataract formation.

Conclusion
In summary, your recurrent episodes of iritis, the association with HLA-B27, and the development of early cataracts highlight the importance of timely and appropriate treatment. It is crucial to work closely with your healthcare provider to manage your uveitis effectively and address any complications that arise. If you are experiencing significant vision changes, it may be time to discuss cataract surgery options with your ophthalmologist. Regular monitoring and a proactive approach to treatment can help maintain your vision and overall eye health.

Similar Q&A

Post-Cataract Surgery: Managing Uveitis and Vision Fluctuations

In March of this year, after undergoing cataract surgery on the left eye, I experienced good results except for some flashes of light. Thirty days later, I had cataract surgery on the right eye, which went well initially. However, a week later, my vision began to deteriorate. Aft...

Dr. Gao Pilin reply Ophthalmology
Hello, Afu: After cataract surgery, the management of iritis should be based on clinical symptoms, and whether vision will be affected can only be determined through clinical follow-up. If the attending physician believes they cannot manage the case, they should refer you to an a...

Can Surgery Cure Uveitis Beyond Steroid Treatments?

Is it possible to achieve a cure through surgical treatment, aside from the use of corticosteroids? Thank you!

Dr. Wu Shengping reply Ophthalmology
Typically, treatment involves the use of steroid medications or other types of antibiotic eye drops. Surgery is only considered if the intraocular pressure is very high or persistently elevated.

Understanding Uveitis: Treatment Options and Management Strategies

I was hit in the left eye by a stone when I was young, and later underwent surgery to remove the blood clot. Everything has been fine for almost 40 years, but in the past six months, my left eye has frequently been swollen, painful, light-sensitive, and blurry. Some doctors have ...

Dr. Gao Pilin reply Ophthalmology
Hello, A-Wen: 1. Simple iritis can be alleviated with steroid treatment; whether additional examinations are necessary depends on the physician's clinical diagnosis. 2. Sometimes, it may not be necessary to use mydriatics, depending on the inflammation status. 3. Occasionall...

Managing Corneal Opacities: Treatment Options and Concerns

Hello, doctor. I have been dealing with corneal opacities caused by viral conjunctivitis for over a year now, and I am currently using Lotemax eye drops. The ophthalmologist diagnosed the corneal opacities as inflammation and frequently prescribes steroid eye drops for treatment....

Dr. Gao Pilin reply Ophthalmology
Hello: Corneal leukoma is an ophthalmic condition caused by inflammation, and the use of steroid eye drops is a common treatment method. However, different individuals may require different treatment plans, and not everyone is suitable for steroid eye drops. If intraocular pressu...