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Suggest Treatment For Recurrent Photophobia
Question: My wife (Age 31) is suffering from Photophobia from almost 10 years. Earlier the attack were once in a year, but since last year (Oct 2013) attacks are almost every month.
During attack she has to completely cover her eyes with cloth and has to be in a dark room and cannot see even zero bulb light.
Dr Bhaskaran (Sankara Netralaya) sent us below email after I sent him details of her condition again last week.
"Hi from u r history my diagnosis is recurrent viral keratouveitis . This can flare up due to various reasons and hormonal fluctuations are one such cause."
Please advise if there is any Test/Treatment for this problem.
Present medications going on:
4 times Predacetate
4 times Restassve
4 times refresh tears
Homide drops (3 days, today is 3rd day): 2 times
Omnacortil 10mg (8days 1tab at night)
Present condition:
1. Today she is observing blurred vision.
2. Pain in both eyes is reduced in these 3 days.
3. But still eyes are sensetive to light and there is irritation.
4. After closing eyes if we touch eyes there is pain in both eyes.
During attack she has to completely cover her eyes with cloth and has to be in a dark room and cannot see even zero bulb light.
Dr Bhaskaran (Sankara Netralaya) sent us below email after I sent him details of her condition again last week.
"Hi from u r history my diagnosis is recurrent viral keratouveitis . This can flare up due to various reasons and hormonal fluctuations are one such cause."
Please advise if there is any Test/Treatment for this problem.
Present medications going on:
4 times Predacetate
4 times Restassve
4 times refresh tears
Homide drops (3 days, today is 3rd day): 2 times
Omnacortil 10mg (8days 1tab at night)
Present condition:
1. Today she is observing blurred vision.
2. Pain in both eyes is reduced in these 3 days.
3. But still eyes are sensetive to light and there is irritation.
4. After closing eyes if we touch eyes there is pain in both eyes.
Brief Answer:
She is probably having recurrent uveitis.
Detailed Answer:
Hello
Welcome to Health Care Magic
I am Dr. DADAPEER K, an Ophthalmologist and I answer health problems related to eye.
I went through the medications she is currently taking and her reports and my views are
It seems from the history that your wife is having recurrent episodes of photophobia for last 10 years.
She is presently treated for uveitis which is inflammation of eye which is typically recurrent in nature.
But since vision is normal and ocular examination is normal the disease seems to be mild when examination was done.
Since she has undergone most of the laboratory tests like ESR, CRP, ANA, RA and all of them are in normal range no need to worry.
The treatment she is on is in right direction and she can continue the same as per the advice of doctor.
Uveitis is a recurrent inflammation of the uveal tract of the eye and most of the times even after extensive investigations no underlying cause can be found out. But most of them will respond to treatment and only problem which needs to be taken care is the complication of the recurrent attacks. Since the last examination which was done on 21-02-2014 is normal with no evidence of such complications and most importantly the vision is normal, there is no need to worry.
As the present condition is showing improvement in pain she can continue the same treatment and I feel no addition tests are required.
Along with the above mentioned conditions the diseases I would like to consider are narrow angle glaucoma and migraine headache which also present with similar and recurring symptoms.
Since the ocular examination is normal with normal intraocular pressure and normal anterior chamber this rules out narrow angle glaucoma.
The other thing need to be considered is migraine. This can be ruled out by examination with physician. I advice to get a consultation with physician if not already done.
Hope the information is helpful to you.
Thank you
With regards
She is probably having recurrent uveitis.
Detailed Answer:
Hello
Welcome to Health Care Magic
I am Dr. DADAPEER K, an Ophthalmologist and I answer health problems related to eye.
I went through the medications she is currently taking and her reports and my views are
It seems from the history that your wife is having recurrent episodes of photophobia for last 10 years.
She is presently treated for uveitis which is inflammation of eye which is typically recurrent in nature.
But since vision is normal and ocular examination is normal the disease seems to be mild when examination was done.
Since she has undergone most of the laboratory tests like ESR, CRP, ANA, RA and all of them are in normal range no need to worry.
The treatment she is on is in right direction and she can continue the same as per the advice of doctor.
Uveitis is a recurrent inflammation of the uveal tract of the eye and most of the times even after extensive investigations no underlying cause can be found out. But most of them will respond to treatment and only problem which needs to be taken care is the complication of the recurrent attacks. Since the last examination which was done on 21-02-2014 is normal with no evidence of such complications and most importantly the vision is normal, there is no need to worry.
As the present condition is showing improvement in pain she can continue the same treatment and I feel no addition tests are required.
Along with the above mentioned conditions the diseases I would like to consider are narrow angle glaucoma and migraine headache which also present with similar and recurring symptoms.
Since the ocular examination is normal with normal intraocular pressure and normal anterior chamber this rules out narrow angle glaucoma.
The other thing need to be considered is migraine. This can be ruled out by examination with physician. I advice to get a consultation with physician if not already done.
Hope the information is helpful to you.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the feedback,
She was already given medication for probable migraine, I have attached her medication copy for your reference but there was no improvement.
I just want to know if this problem due to hormonal cause and if yes which blood tests can be done.
Secondly, we have been told that there are some severe side effects if there is continuous use of predacetate, Restassve eye drops and Omnacortil tablets.
Still her condition after use of above medication is she cannot face even slight light as eyes start paining. and in these 2 months there has been 3 attacks.
Please suggest the possible blood tests or eye tests which can be done during attack period so that our local Ophthalmologist can do.
Also suggest which medications we can continue so that there no more further severe attacks.
Looking forward for your guidance!
She was already given medication for probable migraine, I have attached her medication copy for your reference but there was no improvement.
I just want to know if this problem due to hormonal cause and if yes which blood tests can be done.
Secondly, we have been told that there are some severe side effects if there is continuous use of predacetate, Restassve eye drops and Omnacortil tablets.
Still her condition after use of above medication is she cannot face even slight light as eyes start paining. and in these 2 months there has been 3 attacks.
Please suggest the possible blood tests or eye tests which can be done during attack period so that our local Ophthalmologist can do.
Also suggest which medications we can continue so that there no more further severe attacks.
Looking forward for your guidance!
Brief Answer:
She needs to continue the same medications.
Detailed Answer:
Hello
Thank you for the follow up question.
I went through the reports attached with the question and she has been treated with drugs for migraine.If there is no improvement it rules out migraine as a probable cause and it confirms uveitis as to be the supposed cause.
Hormones can influence various inflammatory diseases and uveitis is one among them. Since she has undergone most of the tests to find out underlying cause and all of them are normal I do not advice further tests.
There are few side effects of using steroid eye drops like predacetate and steroid drugs like Omnacortil tablets on the eye like formation of cataract, glaucoma and all of them can be detected by regular examination. Since for the control of the disease they are necessary she can take them as per your doctors advice.
During acute attack your ophthalmologist can do slit lamp examination and blood tests like ESR, CRP.
The other advice I want to give is her is as the examination of the eye is showing papillae in the conjunctiva which suggests allergic etiology, she needs to avoid any allergen like dust, pollen, exposure to plant dust....
Most of these inflammatory conditions tend to resolve over time, hence as of now she needs to continue the treatment.
Along with all these medications use of artificial tears eye drops like refresh tears provides symptomatic relief from photophobia.
Hope the information is helpful to you.
Thank you
She needs to continue the same medications.
Detailed Answer:
Hello
Thank you for the follow up question.
I went through the reports attached with the question and she has been treated with drugs for migraine.If there is no improvement it rules out migraine as a probable cause and it confirms uveitis as to be the supposed cause.
Hormones can influence various inflammatory diseases and uveitis is one among them. Since she has undergone most of the tests to find out underlying cause and all of them are normal I do not advice further tests.
There are few side effects of using steroid eye drops like predacetate and steroid drugs like Omnacortil tablets on the eye like formation of cataract, glaucoma and all of them can be detected by regular examination. Since for the control of the disease they are necessary she can take them as per your doctors advice.
During acute attack your ophthalmologist can do slit lamp examination and blood tests like ESR, CRP.
The other advice I want to give is her is as the examination of the eye is showing papillae in the conjunctiva which suggests allergic etiology, she needs to avoid any allergen like dust, pollen, exposure to plant dust....
Most of these inflammatory conditions tend to resolve over time, hence as of now she needs to continue the treatment.
Along with all these medications use of artificial tears eye drops like refresh tears provides symptomatic relief from photophobia.
Hope the information is helpful to you.
Thank you
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks for your reply, helped us a lot in understanding problem!
there are few more points which we want to ask
1. 10 years back we took a hormonal treatment for female harmon imbalance but could not continue since she was not able to digest the powerful medication...treatment was started as she had a miscarriage and there was problem in conceiving.
after this hormonal treatment Photophobia started but earlier frequency of attack was only once in a year and that also in one eye only alternate eye every year.
2. Also there was a abortion done for 6 mth pregnancy due to some complications.
3. In 2009 XXXXXXX we got blessed with a baby and after that there was no attack for a period of 4 1/2 years. Attacks have started back again after 4 1/2 years from Oct 2013 last year and there are repeated attacks almost every month and there was only in Feb and march 2014 eye were normal.
4. She also took an hair teatment from XXXXXXX clinic with the help of a roller. And laser treatment for chin hairs,
please suggest if there is probabilty that due to harmonal medication this problem is triggered and are the any test which we can do to detect.
2. Is there a probability that due to hair treatment this problem occurred and is there any way we can get some tests done.
3. should we go for MRI with consultation of a neurologist to check if any problem is in nerves.
4.she actually has a hipper acidity and also some times when she eat cold and spicy thing together a black ulcer type develops near her tongue or at sides of tongue. can this eye problem be related with acidy.
5.Last year for constipation she took a homeopathic treatment and just after completing 1 mth of medication photophobia started back afer 4 1/2 years. Can this be linked to the reason of come back of her eye problem.
as you have stated that due to dust plant dust this can get triggered, can you please suggest what are the other probable things which can cause infection so that we will avoid those as much as possible to get her eyes back to normal.
many people and few doctors have advised us to go for homeopathy treatment. Plz suggest.
looking forward for your reply....
there are few more points which we want to ask
1. 10 years back we took a hormonal treatment for female harmon imbalance but could not continue since she was not able to digest the powerful medication...treatment was started as she had a miscarriage and there was problem in conceiving.
after this hormonal treatment Photophobia started but earlier frequency of attack was only once in a year and that also in one eye only alternate eye every year.
2. Also there was a abortion done for 6 mth pregnancy due to some complications.
3. In 2009 XXXXXXX we got blessed with a baby and after that there was no attack for a period of 4 1/2 years. Attacks have started back again after 4 1/2 years from Oct 2013 last year and there are repeated attacks almost every month and there was only in Feb and march 2014 eye were normal.
4. She also took an hair teatment from XXXXXXX clinic with the help of a roller. And laser treatment for chin hairs,
please suggest if there is probabilty that due to harmonal medication this problem is triggered and are the any test which we can do to detect.
2. Is there a probability that due to hair treatment this problem occurred and is there any way we can get some tests done.
3. should we go for MRI with consultation of a neurologist to check if any problem is in nerves.
4.she actually has a hipper acidity and also some times when she eat cold and spicy thing together a black ulcer type develops near her tongue or at sides of tongue. can this eye problem be related with acidy.
5.Last year for constipation she took a homeopathic treatment and just after completing 1 mth of medication photophobia started back afer 4 1/2 years. Can this be linked to the reason of come back of her eye problem.
as you have stated that due to dust plant dust this can get triggered, can you please suggest what are the other probable things which can cause infection so that we will avoid those as much as possible to get her eyes back to normal.
many people and few doctors have advised us to go for homeopathy treatment. Plz suggest.
looking forward for your reply....
Brief Answer:
She seems to be having recurrent uveitis.
Detailed Answer:
Hello
Thank you for the follow up question.
Hormonal levels like estrogen levels play an important role in the maintenance of normal ocular tissue. Decrease in the level of the hormones is usually associated with inflammations of the eye.
The laser treatment for the hairs is not related to the eye condition.
The acidity and treatment for constipation is also not related to eye condition.
In this case I do not think there is any need for MRI and neurologist opinion.
If there is any problem other than eye condition which indicate hormonal dysfunction like irregular periods then need to consult endocrinologist or gynecologist for evaluation.
Regarding eye condition she is probably having recurrent uveitis and treatment she is on is in right direction and she needs to continue it. For photophobia she can use artificial tears eye drops like refresh tears. Uveitis is known to be a recurrent condition and usually have periods of remissions and acute episodes. Hence I advice you not to worry as she may be having period of acute episodes and it will come to remission period soon.
Since you have undergone extensive evaluation at Sankara Nethralaya and all tests have come normal I do not feel any requirement for further investigations.
Hope the information is helpful to you.
If you have any further question please do ask me.
Thank you
With regards
She seems to be having recurrent uveitis.
Detailed Answer:
Hello
Thank you for the follow up question.
Hormonal levels like estrogen levels play an important role in the maintenance of normal ocular tissue. Decrease in the level of the hormones is usually associated with inflammations of the eye.
The laser treatment for the hairs is not related to the eye condition.
The acidity and treatment for constipation is also not related to eye condition.
In this case I do not think there is any need for MRI and neurologist opinion.
If there is any problem other than eye condition which indicate hormonal dysfunction like irregular periods then need to consult endocrinologist or gynecologist for evaluation.
Regarding eye condition she is probably having recurrent uveitis and treatment she is on is in right direction and she needs to continue it. For photophobia she can use artificial tears eye drops like refresh tears. Uveitis is known to be a recurrent condition and usually have periods of remissions and acute episodes. Hence I advice you not to worry as she may be having period of acute episodes and it will come to remission period soon.
Since you have undergone extensive evaluation at Sankara Nethralaya and all tests have come normal I do not feel any requirement for further investigations.
Hope the information is helpful to you.
If you have any further question please do ask me.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your reply....
Need to ask few more points before closing off.
1. Yes she has irregular periods, please advise if this need to be checked. I consulted her gynac but she told there is no relation of this with eye problem. Plz suggest.
2. Itching in eyes starts before start of acute attack. Please suggest if there is any medication which can be given prior to avoid major problem the very next day. Also advise if this can be linked to her problem.
3. Pain during periods: we have observed that during her menestrual cycle pain in eyes increases or starts and this we have observed since last oct 13. Please advise if this can be linked to her harmonal problem. This is our personal observation. Just wanted to share if it would help your analysis.
4. Allergy: as you have noticed that due to dust, plant dust there can be inflamation in eyes. Yes I believe this as a main cause as earlier when ever she did dusting or cleaning of house there was redness in eyes (before marriage). Please advise if allergy medication (oral tabs)can help in this condition. Also advise what are the other type of allergies which we should avoid other that dust and plant dust. This will help us in avoiding major attacks.
5. Pain due to light: please advise if exposure to light increases problem as we have obseverved exposure to light increases pain in eyes the very next day. Most of the doctors say that exposure to light do not increase problem in eyes but as per our observation problem has increased on exposure to light.
6. Touch in eyes feels pain: there is pain in eyes if touched over closed eyes and pain is in alternate eyes every day. Plz advise if it is usually observed. Or does this indicates some other problem.
7. Can we wash eyes with water (at present we use RO water for her face care).
8. Does closing eyes or covering eyes with clothes help to reduce the severiety of attack/problem.
9. Does phone use or laptop use during normal eye routine can cause this problem.
10. During acute attack we use preacetate drops 6 times a day and then tapper 5,4,3,2,1 weekly. But sometimes there is attack at the time of 4 times weekly tapper. So should we continue 4 times a day or increase to 6 times a day and then follow weekly tapper.
11. As she being health conciouse we just want to inquire if cardio exercises may result in increase in eye presure while using preacetate and omnacortil tabs. Or can we continue pysical exercises along with the present medications.
There has been a great help till now hope to get proper feedback and suggestions in future...
Thanks for your help in advance!
Need to ask few more points before closing off.
1. Yes she has irregular periods, please advise if this need to be checked. I consulted her gynac but she told there is no relation of this with eye problem. Plz suggest.
2. Itching in eyes starts before start of acute attack. Please suggest if there is any medication which can be given prior to avoid major problem the very next day. Also advise if this can be linked to her problem.
3. Pain during periods: we have observed that during her menestrual cycle pain in eyes increases or starts and this we have observed since last oct 13. Please advise if this can be linked to her harmonal problem. This is our personal observation. Just wanted to share if it would help your analysis.
4. Allergy: as you have noticed that due to dust, plant dust there can be inflamation in eyes. Yes I believe this as a main cause as earlier when ever she did dusting or cleaning of house there was redness in eyes (before marriage). Please advise if allergy medication (oral tabs)can help in this condition. Also advise what are the other type of allergies which we should avoid other that dust and plant dust. This will help us in avoiding major attacks.
5. Pain due to light: please advise if exposure to light increases problem as we have obseverved exposure to light increases pain in eyes the very next day. Most of the doctors say that exposure to light do not increase problem in eyes but as per our observation problem has increased on exposure to light.
6. Touch in eyes feels pain: there is pain in eyes if touched over closed eyes and pain is in alternate eyes every day. Plz advise if it is usually observed. Or does this indicates some other problem.
7. Can we wash eyes with water (at present we use RO water for her face care).
8. Does closing eyes or covering eyes with clothes help to reduce the severiety of attack/problem.
9. Does phone use or laptop use during normal eye routine can cause this problem.
10. During acute attack we use preacetate drops 6 times a day and then tapper 5,4,3,2,1 weekly. But sometimes there is attack at the time of 4 times weekly tapper. So should we continue 4 times a day or increase to 6 times a day and then follow weekly tapper.
11. As she being health conciouse we just want to inquire if cardio exercises may result in increase in eye presure while using preacetate and omnacortil tabs. Or can we continue pysical exercises along with the present medications.
There has been a great help till now hope to get proper feedback and suggestions in future...
Thanks for your help in advance!
Brief Answer:
I have answered quesyions in serial order.
Detailed Answer:
Hello
Thank you for the follow up question
1. Irregular periods needs to be treated with consultation with gynaecologist. She is correct in saying that there is no relation of this with eye problem.
2. For itching of eyes you need to take anti allergic eye drops and antihistaminic drugs.
3. Pain during periods and eye pain is related to hormonal variations.
4. Oral tablets in the form of antihistaminic drugs and anti allergic drugs like cetrizine will help in controlling allergy. Only external allergies like dust and plants can be avoided. Internal allergies cannot be prevented.
5. Exposure to light does not increase the disease but it increases the pain because of stimulation of nerve endings.
6. Pain in the eye indicate inflammation and will decrease with treatment.
7. She can wash her eyes with water.
8. Covering the eyes with cloth will provide symptomatic relief and will not reduce the severity of disease.
9. Routine use of phone or laptop will not cause this problem however need to avoid over use.
10. During acute attack you can increase the dosage of predacetate to 6 times per day and then taper.
11. Physical exercises and cardio exercises can be continued with medications they will not do any harm.
Hope I have answered your questions.
Thank you
With regards
I have answered quesyions in serial order.
Detailed Answer:
Hello
Thank you for the follow up question
1. Irregular periods needs to be treated with consultation with gynaecologist. She is correct in saying that there is no relation of this with eye problem.
2. For itching of eyes you need to take anti allergic eye drops and antihistaminic drugs.
3. Pain during periods and eye pain is related to hormonal variations.
4. Oral tablets in the form of antihistaminic drugs and anti allergic drugs like cetrizine will help in controlling allergy. Only external allergies like dust and plants can be avoided. Internal allergies cannot be prevented.
5. Exposure to light does not increase the disease but it increases the pain because of stimulation of nerve endings.
6. Pain in the eye indicate inflammation and will decrease with treatment.
7. She can wash her eyes with water.
8. Covering the eyes with cloth will provide symptomatic relief and will not reduce the severity of disease.
9. Routine use of phone or laptop will not cause this problem however need to avoid over use.
10. During acute attack you can increase the dosage of predacetate to 6 times per day and then taper.
11. Physical exercises and cardio exercises can be continued with medications they will not do any harm.
Hope I have answered your questions.
Thank you
With regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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