Uveitis is inflammation of the middle eye

DEAR DR. ROACH: For the past several months, I’ve had problems in my right eye. The eye was bloodshot and painful, and vision was blurry. I was diagnosed with uveitis, and the doctors didn’t know why it happened. I’ve had full lab work and chest X-rays. I have been treated with prednisolone and Cyclogyl (I eased off the Cyclogyl).
I’d like to know more about this disease. I’m 85 years old and am afraid of losing my eyesight. — P.S.
ANSWER: The uvea is the middle portion of the eye. The suffix “-itis” means “inflammation.” So, uveitis is inflammation of the structures of the middle part of the eye. These include the iris (the colored portion of the eye, which constricts around the pupil), the ciliary body (which controls the shape of the lens and secretes the fluid of the middle of the eye) and the choroid (which contains the blood vessels of the globe of the eye).
Uveitis can occur as a result of infection from bacteria, viruses and parasites. It also can happen as a result of systemic inflammatory conditions, such as ankylosing spondylitis or sarcoidosis, which is when I, as an internist, usually see it. Uveitis also can occur as a side effect of medication.
Uveitis can occur just as a primary eye disease, and there are several subtypes, such as pars planitis and birdshot choroidopathy. Sometimes no specific cause is ever found.
Treatment depends on the underlying cause. Infections are treated with specific antimicrobials, if possible. If no clear cause is found, the inflammation is treated by anti-inflammatory medicines, like prednisolone eyedrops. Cyclopentolate (Cyclogyl) relieves spasm of the ciliary muscles and may prevent complications.
Uveitis treatment requires an eye-care professional. The prognosis for most people with uveitis is very good, and vision loss is unlikely if it is treated promptly.
DEAR DR. ROACH: Yesterday, while walking barefoot in my back yard, I stepped on a bee. This has happened to me before, and it seems that each time the results are a little worse. After I removed the stinger from the underside of one of my toes, I put ice on the sting and took a Benadryl. Since this happened in the evening, I was able to elevate my leg for the rest of the night. In the morning, the area was swollen, red, hot and painful. Now, after my usual three-mile morning power walk, the swelling and soreness of the area is spreading up my foot.
I am notorious for going barefoot and stepping on bees. I just know this will happen again. Do you have any suggestions for what might help prevent a bee sting from going “viral”?
ANSWER: Your best bet is not to get stung in the first place, which for you means not stepping barefoot where bees might be. It’s particularly important for you, as local reactions to bee stings do tend to get worse over time. Fortunately, they do not usually predict the life-threatening anaphylactic reaction.
Once stung by a bee, remove the stinger, within seconds if possible, since the venom can continue to be released for several seconds. The local reaction usually lasts less than a day in most people, but it can last up to five days.
The reason the swelling and soreness spread after your walk is that the exercise and increased blood flow to the area allowed the venom to move to different areas, and the inflammatory response also progressed. I would recommend that you continue cold compresses and avoid your power walks for at least another day or two after a sting.
READERS: The booklet on edema and lymphedema provides information on the causes of foot and ankle swelling. Readers can order a copy by writing: Dr. Roach — No. 106, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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