Iritis or Uveitis ?

[82ndtrooper]

I've been treated for Iritis and currently am battling yet another out break of the inflammation. This time the Pred-Forte drops and the dialator drops are not working. Bright lights are extremely painful since I cannot get the right eye to dialate with the Cycligel.

I've been tested for Lyme, communicable, ANA, CBC, chem 7, and a whole host of other blood work for the disease, that is if it's a disease that is produced by an autoimmune disorder (Rheumotology)

Synickii have developed and makes the eye harder and harder to dialate with the cyclegel drops. I fear that both the drops are failing to reduce the inflammation and that if left to the current doctors orders that the synikii are going to cause glaucoma.

Any experience with this in the field ? I relize the disclaimers in the stickies for this forum topic, but would like to see if anyone has treated this, or has had experience with alternative methods of treatments.

Would oral Prednisone be a secondary course of action? or should I just opt for an intro ocular injecton ? I'll be seeing an opthamologic disease specialist on Thursday.

If this is an off topic thread, then I relize the need to shut it down.

Thanks in advance for any experiences related to this in the field by any of the 18D's

[Eagle5US]

Originally Posted by 82ndtrooper

I'll be seeing an opthamologic disease specialist on Thursday.

Unfortunately you have passed into the realm of clinical subspecialists. These are the guys who are clinically, legally, and comfortably able to do what all the warning labels and disclaimers warn other practioners about regarding treatment, recommended dosages, and invasive parameters.
Do the best you can to hold out until your appointment. Wear the dark glasses and do all of the pupillary rest precautions associated with your standard treatment regimen.
If all else fails and you have reached your threshhold, call his office and ask if he would be willing to meet you at the ED.

Good Luck-
Eagle

[82ndtrooper]

Today I visited with a specialist in ophthamologic disease for acute iritis as described in the first post of this thread.

I've been grappling with the condition for two weeks, although diagnosed some 9 years ago with this condition. It rarely gives me trouble and when it does a couple of day's of diolating drops and Pred-Forte steriodial anti inflammatory drops does the job. Not this time.

Since my visit on Saturday the inflammation has cleared up considerably and the adhesions to the iris and the lens are all but practically pulled loose from the diolating drops that relax the iris and pull them apart from the lens. That was the good news, but not without blurred vision and some redness due to the inflammation. Both of which are markedtly improved since Saturday.

Apparently there are some kind of bacteria that adhere to the lens of the eye and are creating the blurred vision. The specialist insisted that I be given an intro ocular injection into the anterior chamber between the iris and the lens to improve the removal of this bacteria. Here's the good part.

He used numbing drops on the eye, 3 drops and a 5 minute wait, then I had to look to the left as he inserted the needle into the eye ball into the anterior chamber to inject the sterioid med. I felt a bit of pressure, but no pain. All was fine and he said "That's it, it's over" Just as he said that my vision began to close in from the periphery and I said "Doc, I think I'm going to lose you"

Next thing I know, I am being cropped up in an ambulance and being IV'd on the way to the ER at St. E's. WTF ?

I had passed out. Ok, no big deal, but my heart rate had gone down to less than 40 bpm and they were concerned that I was going into heart failure. After being carted into the ER and and EKG hooked up the heart rate was beginning to steady at a rate of 75-80 bpm. All this over an eye that is inflammed. After being monitored for an hour I began to have one of the most painful migraines that I have ever experienced. The ER doc orders 50 mg's of demerol and 25 mg's of the phenagan.....................again my heart rate goes to about 60 bpm once they push the pain meds and they put me on oxygen. Bad call to use an opiod pain med just after I had slow heart rate due to what I would probably call merely shock or psycho trauma after the injection.

Never the less, I'm home and still feeling happy from the demerol in the IV.

I'll never let another doctor put a needle in my eye. And, I dont have any idea why my body responded as it did.

[Eagle5US]

Dude-
Glad you are A-OK. You may have vagal'ed out. There are things we do when people have a "runaway heartbeat" like put there face in cold water, stroke their neck and (you are gonna love this) press on their eyeballs. This slows their heart-as you have experienced with your increase in intraoccular pressure.
I hate that e started you with narcs for your resultant headache....and DEMEROL at that-YIKES- I haven't pushed demerol in years with so many other (better) drugs out there for use. But, medicine being a practice....people practice differently.

Thank you for keeping us posted-let us know how this turns out for you.

Eagle

[82ndtrooper]

EAGLE,

Sincerely thank you for your concern. Your right, the doc at the ER said it was fairly normal to "Vagal" out when given an intro occular injection. I was transported to the ER under federal guidlines for treatment that is considered ordinary and usual.

The eye feels much better, the adhesions seems to be breaking off due to a larger diameter of the pupil from the diolating drops and the redness and inflammation seem to be disapearing, albeit, slower than I would like.

The ER doc took mercy on me and prescribed a few 5/500 Vicodin for early morning pain since the mornings are when the eye has not received it's required drops during sleep. Honestly, I dont even like the idea of using an opiod pain killer for pain that can be managed by a couple of extra strength Tylenol. I did ask as to why he ordered Demerol for a migraine and he said that most triptans have proven unreliable for immediate abortive migraine pain. At least in his years of ER practice. He also pushed an non sterioidal anti inflammatory to reduce the chance of a rebound migraine. The Demerol certainly puts you in a good mood, but he actually said that 50 mg's is a fairly small dose compared to other doses for more injurious pain.

Thanks for your follow up post and your concern.

[jasonglh]

Damn my eyes are watering just thinking about that. Glad to hear you are doing better though.

Eagle5US

I think drug choice is a hospital thing. In my wifes ICU they use morphine but where I work its usually demerol or dilaudid. Didn't know you could vagal someone down by eye pressure I learn something every day here.

[Eagle5US]

Originally Posted by 82ndtrooper

EAGLE,
I did ask as to why he ordered Demerol for a migraine and he said that most triptans have proven unreliable for immediate abortive migraine pain. At least in his years of ER practice.

He is absolutely correct (and backed by the literature) in knowing that triptans are relatively ineffective after the spasm / pain cycle has been initiated. Without getting into the pharmacokinetics of it, a successful initial "migraine pharmacotherapy" consists of Compazine, Phenergan and Benedryl and some add Toradol (the NSAID you probably received) pushed IV. This combination has been shown to have a higher efficacy in relieveing migraine headaches than narcotic therapy as it works on the cause of the HA itself, not the pain receptors associated with it. HA's that are refractory to this coctail and have entered the pain cycle do then need narcotherapy for patient comfort until the HA resolves.
Demerol has a VERY hgh side effect rate, but is dirt cheap and has been around long enough for many folks to be very comfrortable prescribing it. Though I have had tremendous success with it 10 years ago, with the advent of medications such as fentanyl and dilauded, most practioners I have worked with in Emergency Departments and Trauma Centers rarely utilize it today.

Not gospel-only my opinion and the way I practice.

Eagle