Tag Archives: NSAIDS

Proliferative Vitreoretinopathy (PVR)

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Eye
Vitreous is the gel that fills the eye (click on image to enlarge)

See Anatomy of the Eye

What is PVR?

The retina is a “tissue-paper” thin layer of nerve tissue that lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Proliferative vitreoretinopathy is a condition in which sheets of scar tissue grow on the surface of the retina. It usually occurs after retinal detachment as a part of the healing process. Unfortunately, the PVR scar tissue pulls on the retinal and is the most common cause of failure of attempted repair of retinal detachment. There is evidence of PVR in about 10% of eyes that present with retinal detachment.

What is retinal detachment?

When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera.  When this occurs, a camera cannot take a picture. Similarly, when the retina detaches the eye loses vision.

What causes PVR?

Proliferative vitreoretinopathy is caused by the excessive formation of scar tissue. Scar tissue is a common healing mechanism in the body. For example, if the skin is cut, scar tissue closes the laceration. In the eye scar tissue develops in response to retinal detachment and surgical repair. If it becomes excessive, the scar tissue causes the retina to detach again. The abnormal production of scar tissue in the eye is called PVR. Tobacco use may increase the risk of PVR.

How is PVR treated?

The treatment of PVR requires one or more surgeries. Your doctor is skilled in a number of techniques to prevent blindness. Which type of surgery is recommended depends on the precise findings on examination.

Scleral buckle surgery:  Some retinal detachments require the placement of a permanent plastic supporting belt around the eye to create a “ledge of support” for the retina. This belt is placed in the hospital operating room in a major surgery. The eye is often rendered more near sighted by this procedure. Rarely, side effects include double vision.

Vitrectomy surgery:  Performed in the hospital operating room as a major eye surgery, vitrectomy surgery involves making small incisions into the eye to remove floaters, dissect scar tissue, remove fluid from under the retina, apply laser, and place a gas bubble or silicone oil into the eye to hold the retina in place. Specific head positioning is sometimes needed.  Sometimes a cataract or lens implant must be removed to adequately repair the retina. After surgery, it may be necessary to lie in a specified position for several days for success. This surgery may be repeated if necessary to prevent blindness.

With one or more surgeries most retinal detachments with PVR can be repaired keeping useful vision. The vision usually does not return to normal. It is frequently blurred or distorted. There are always risks to surgery including hemorrhage, infection, scarring, glaucoma, cataract, and double vision. Sometimes despite all efforts with surgery, all vision may be lost. Surgery is recommended for retinal detachments with PVR because blindness usually results if treatment is withheld. If you have questions, please do not hesitate to ask your doctor.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2017-2023 Designs Unlimited of Florida.  All Rights Reserved.

Anterior Uveitis (Iritis)

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is iritis?

Iritis (pronounced, “eye-RYE-tis”) is a general term used to describe inflammation in the front of the eye. Specifically, it means inflammation of the iris. The iris is the name given to the layer of tissue in the eye that gives it a brown or blue color and serves to protect the eye from excessive light. Iritis is also called anterior uveitis.

What causes iritis?

Iritis may be caused by systemic inflammatory disease, trauma, infection, or sometimes for unknown reasons. Infection by a virus, bacterium, fungus, or other parasite rarely causes iritis. Infections may be limited to the eye or may involve other organs as well. More commonly, iritis is caused by inflammation without infection. For example, sarcoidosis, arthritis, lupus, and inflammatory bowel disease may cause iritis. The most common type of arthritis that causes iritis is ankylosing spondylitis, a condition that causes low back stiffness in the morning. Iritis also commonly follows an injury to the eye. In some cases, no underlying cause of iritis can be found.

What are the symptoms of iritis?

The eye may be painful, red, tearing, and light sensitive. Tiny floating spots which move or “float” may be seen. Symptoms may be mild, or they may be severe and disabling. Iritis may cause glaucoma, cataract, or scarring of the iris producing a distorted pupil (the part of the eye that is normally round and black). Blurred vision is common, and blindness may occur if iritis is not treated.

 How is iritis managed?

When the doctor diagnoses iritis, laboratory tests may be ordered to help determine its cause. A questionnaire may be reviewed. Occasionally, a surgical biopsy is needed. If infection is found, antibiotics are prescribed. Dilating drops are used to limit pain and scarring of the iris. To limit the damage from inflammation, iritis is treated with anti-inflammatory medication in the form of eye drops (steroid and non-steroid), injections, or prednisone pills. The eye drops must be used very frequently to break an acute attack of iritis. Sometimes, non-steroid pills (e.g. methotrexate) or biologics (e.g. Humira) maybe needed. Aggressive treatment is recommended to prevent complications and permanent injury to the eye. Surgery may be required to treat complications of iritis such as glaucoma and cataract. Iritis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor promptly and taking the medications exactly as recommended, permanent damage from iritis can be minimized. In some cases, iritis can return in either eye at a future date. Therefore, if you become aware of the return of symptoms of iritis in the future, contact your doctor without delay.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Uveitis

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is uveitis?

Uveitis (pronounced, “you-vee-EYE-tis”) is a general term used to describe inflammation inside the eye. The uvea is the name given to the layer of tissue in the eye that has a brown color (melanin pigment) and blood vessels, which serve to provide blood supply and protect the eye from excessive light. The uvea can be divided into separate parts, which perform different functions in the eye: the iris, the ciliary body, the pars plana, and the choroid. The part of the uvea in the front of the eye is called the iris (the round, blue or brown part of the eye that you can see in the mirror). Behind the iris is the ciliary body, which produces the fluid that fills the eye. The pars plana serves as the boundary between the ciliary body and the choroid. The back part of the uvea that lies under the retina (the “film” in the eye that “takes the picture”) is called the choroid. Therefore, in any one patient uveitis is usually given a more specific name depending on where most of the inflammation is located in the eye. For example, inflammation of the iris is called iritis. When inflammation is mainly in the central vitreous gel of the eye, it is called intermediate uveitis.

What causes uveitis?

Uveitis may be caused by infection, injury from trauma, disease in the body outside the eye, or sometimes for unknown reasons. Infection by a virus, bacteria, fungus, or other parasite may cause uveitis. Infections may be limited to the eye or may involve other organs as well. In other cases uveitis is caused by inflammation without infection. For example, arthritis, multiple sclerosis, lupus, and inflammatory bowel disease may cause uveitis. Uveitis commonly occurs following an injury to the eye. In some cases, no underlying cause can be found to be the cause of uveitis. Very rarely, cancer may cause uveitis. Tobacco may be an aggravating factor and should be discontinued.

What are the symptoms of uveitis?

Various symptoms may be experienced depending on where is uvea is most inflamed. Symptoms may be mild or they may be severe and disabling. The eye may be painful, red, tearing, and light sensitive. Tiny floating spots which move or “float” may be seen. Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs.

How is uveitis managed?

To effectively treat uveitis it is important to find the underlying cause whenever possible. Take some time to carefully review and report to your doctor any unusual or unexplained symptoms (see uveitis questionnaire) such as rashes, inflamed tattoos, back and joint problems. Tell your doctor if you have been exposed to TB (tuberculosis), traveled abroad, spent time in rural settings, or may be exposed to animals or infections. Heredity may also play a role. You should tell your doctor about any family members with inflammatory disorders anywhere in the body. Also, review and report your ancestry (for example, Asian, Mediterranean, or American Indian ancestry). When the doctor diagnoses uveitis, laboratory tests may be ordered to help determine its cause. Occasionally, a surgical biopsy is needed for diagnosis.   If infection is found, antibiotics are prescribed. To limit the damage from inflammation, uveitis is treated with anti-inflammatory medication in the form of eye drops (steroid and non-steroid), eye injections, and/or systemic therapy (pills or injections into the skin). When systemic therapy is used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist. Rarely, surgery is required to treat uveitis. In some cases, uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision. Uveitis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.

In some cases, uveitis can return at a future date. Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2023 Designs Unlimited of Florida. All Rights Reserved.

Cystoid Macular Edema (CME)

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is cystoid macular edema?

Cystoid macular edema (CME) is an accumulation of fluid in the center of the retina. The fluid is clear like water and comes from abnormal leakage of the blood vessels in the retina. The retina is a thin layer of delicate nerve tissue which lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina which “takes the picture” of objects you look at and sends the message to the brain. The macula is the central area of the retina that gives you sharp central vision and color vision. CME frequently causes a blurring of vision described as fuzzy, hazy, or cloudy. Cystoid macular edema is NOT related in anyway to macular degeneration.

What causes cystoid macular edema?

Although the exact causes of CME are unknown, it may accompany blood vessel problems or inflammation. It most commonly occurs after cataract surgery and may be seen in as many as 3% of eyes undergoing surgery.

How is cystoid macular edema treated?

Since many factors may lead to CME, many different types of treatment are available. Usually weeks to months are required to improve the vision. Sometimes more than one type of treatment is needed for best results. Rarely, vision cannot be restored.

Treatment may include eye drops (steroid, and non-steroid) instilled into the eye several times a day. Sometimes, pills are used to decrease inflammation. Occasionally, medication is injected next to the eye under the eyelid. Anesthetic eye drops help to make the injections painless. Sometimes, surgery is needed to look for infection or remove abnormal scar tissue from inside the eye. With treatment most cases of CME can be managed successfully with improvement in vision. For more information visit www.retinavitreous.com

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2015-2022 Designs Unlimited of Florida. All Rights Reserved.