About a year ago two patients came to me a couple of days apart. One was a farmer in his fifties. Another is a thirty-year-old housewife. Both have similar symptoms. Visual impairment, eye pain, redness and watery discharge within last 10 days.
The first farmer was a regular beedi smoker. On examination, the iris of one eye and the lens behind it were attached. A thin gray film (membrane) was spread over the lens. In addition, small white balls were seen on the edges of Krishnapathalam. All of these are symptoms of acute uveitis/iridocyclitis.
Inflammation is usually our body’s immune response to a sudden infection or change in the body. So I gave steroids to reduce the reaction, mydriatics to relax the eye and dilate the iris. Tuberculosis infection is the most important cause of such eye inflammation in our country. Both patients, a farmer and a housewife, were slightly malnourished with thin body mass. It was found that there is a high probability of people living with tuberculosis in their neighborhood even if they do not have symptoms like fever and cough.
So I sent both of them for a complete blood count test, which measures the cells in the blood, and a Mantoux test, which is a skin prick test to see if there are tuberculosis germs. Both came with test reports and could see amazing changes in the eyes with the drops and tablets. Also, as I suspected, both were confirmed to have TB. Normally, when the TB germ enters the body, the body will fight against it.
Tuberculosis can attack the lungs if the immunity is too low. In many people, TB germs can travel to many places in the body and cause reactions there. Eyes are one of them. Tuberculosis-induced inflammation can be seen especially in areas with high blood flow in the body, such as the choroid and the choroid.
If TB is suspected, your doctor will recommend X-rays, smear tests and blood tests. A Mantoux skin injection will also be performed. If the injection site is examined after 48 hours, swelling at the injection site will confirm the presence of TB pathogens in the body. The thirty-year-old woman mentioned above developed swelling within hours of the test injection. By the next morning the swelling had spread all over the arm. This confirmed the presence of tuberculosis germs in his body.
We immediately started combination drug therapy. A 55-year-old man had no swelling on Mantoux test. But there was a notable change in the ESR, a test that measures red blood cells sticking to each other. Also X-ray showed signs of previous TB. Being a regular beedi smoker, any treatment for his cough was due to smoking. He has not taken it. We started six months of combination drug therapy for tuberculosis in both of them. Already the eye problems were greatly reduced by the drops. After 6 months both of them improved their physical condition as they continued to take the pills. They said that they are able to gain weight and eat well.
At the end of the treatment the farmer had an additional problem. Cataracts developed a bit early due to eye inflammation. A cataract that develops due to other eye diseases is called complicated cataract. Stop smoking. I told him to do the surgery soon. A person who attended sporadically until the end of six months of combination drug therapy then stopped attending altogether.
Instead, the lady is still coming for regular check-ups. An elder in their family had a persistent cough and was tested for tuberculosis in the lungs and the elder was also treated. Completely recovered and now doing well.
Another lady. He had recurring eye infections. Posterior uveitis was more common in the back than in the front of the eye. After all the necessary tests were done, a CT scan showed granulomas in the lungs. All these are due to excessive resistance.
He had the same problem four years ago and was already treated with steroids and combination drugs. Now there are no symptoms of tuberculosis. Instead another immune disease, Sarcoidosis, was discovered. Like tuberculosis, small lumps may appear throughout the lungs. It is also a disease that can affect many organs including skin, eyes, bones. So along with the eye treatment, expert opinion was also obtained and he was treated.
It can be observed that in these three patients mentioned above, eye inflammation was manifested as a symptom of another disease within their body. Some patients accept the doctor’s advice as per the ‘pulse of the disease’ and continue to treat the underlying disease. Some people say, ‘I only have problems with my eyes. Just look at it’ and stop the treatment the first time.
Steroid drops, which are primarily prescribed for such eye inflammation problems, may initially need to be instilled four or six times a day. Let’s begin. After the symptoms are correct, it will be reduced gradually. The same goes for oral steroid pills.
We will advise you to gradually reduce the six drops to five, four and three. It may continue for a few more days at the same time if the inflammation does not subside. Some patients require immunosuppressants that are stronger than steroids. These also have other side effects that should be taken care of. Therefore, follow-up testing is required. Those who stop seeing the doctor the first time have increased inflammation and worsened eye problems. Also, the primary disease causing the inflammation can dominate other parts of the body and make the condition worse. Complete recovery may be delayed or impossible.
Certain cancers, medications, and genetic diseases can also cause eye inflammation. Certain types of lenses implanted during cataract surgery, and the preservatives used to process those artificial lenses, have also been seen to cause cataracts. These cause very mild inflammation and can often be treated with prescription pills. Postoperative steroid drops control the mild inflammation caused by the artificial lens at an early stage.
I met a patient last week. He had an eye infection in one of his eyes, which had undergone an operation for hernia ten days ago and had a mesh implanted. While researching whether there is a connection between the two, I happened to read a research paper that said that when a polypropylene mesh is implanted in one place in the body, Cytokines and Interleukins, which indicate an overreaction throughout the body, can be released. “Sir, will the auto run if I turn the mirror?” If the question comes, “It’s like running!” That seemed to say!