Inflammation
Chat Highlights
November 27, 2002

Norma Devine, Editor

On Wednesday, November 27, 2002, Dr. Elliot Werner, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Inflammation."

Moderator:  Welcome back, Dr. Werner. 

Dr. Elliot Werner:  Hello everybody, and happy Thanksgiving. 

Moderator:  Tonight we would like to discuss inflammation:  what it is, what causes it, what the symptoms are, and how it is treated. 

Dr. Elliot Werner:  Inflammation is a mechanism the body uses to protect us from certain potentially harmful agents. 

Moderator:  What causes inflammation?

Dr. Elliot Werner:  The most common causes of inflammation are infection and injury.  The body uses inflammation to fight infection by localizing the infectious agent (bacteria or virus, etc.) to prevent it from spreading widely throughout the body, and to kill and eliminate the infectious agent.  After an injury, the body uses inflammation to promote healing and scar formation. 

Moderator:  Then inflammation can be beneficial? 

Dr. Elliot Werner:  Unfortunately, there are many circumstances where inflammation is excessive or occurs without significant infection or injury.  In those cases, inflammation can do more harm than good and become a problem requiring treatment by itself.  

P:  What are the symptoms of inflammation?

Dr. Elliot Werner:  Traditionally, the four cardinal signs of inflammation, in Latin, are calor, rubor, tumor, and dolor;  that is, heat, redness, swelling, and pain.  

P:  How dangerous is inflammation of the eye? 

Dr. Elliot Werner:  In the eye, inflammation can be very destructive, because of the delicate nature of the structures in the eye, the inability of the body to regenerate most of the structures in the eye, and the inability of modern medicine to replace lost function in the eye.  

P:  Can inflammation cause glaucoma?

Dr. Elliot Werner:  Yes, it can.  It can put substances in the eye that interfere with the normal flow of the fluids in the eye and cause the eye pressure to go up.  Inflammation can also cause scarring of the structures in the eye that regulate the flow of the fluid and destroy their normal function. 

P:  How is inflammation of the eye treated?

Dr. Elliot Werner:  It's treated with drugs called anti-inflammatories.  These include steroids, as well as non-steroidal drugs, such as aspirin and ibuprofen.

P:  Could you please explain trabeculitis?  Other than by elevated IOP (intraocular pressure), how can it be diagnosed?

Dr. Elliot Werner:  Trabeculitis is more theoretical than real. It can only be diagnosed by looking at the eye under a microscope.

P:  By "looking at the eye under a microscope," do you mean at the slit lamp, gonioscopy, in vitro, or what?  Why do you say it's not real?  Could you explain what it's supposed to be in theory?

Dr. Elliot Werner:  Trabeculitis was an idea coined to explain high IOP in eyes with minimal inflammatory signs.  No one has ever shown it really exists, but if you remove the eye or perform an autopsy and look pathologically, you can see inflammation in the trabecular meshwork.

P:  Is ibuprofen used for red eye to calm the inflammation?

Dr. Elliot Werner:  That depends on the cause of the inflammation.  Some, like scleritis, respond well to ibuprofen or similar drugs.  Others, like conjunctivitis (pink eye), do not.

P:  I've just started using Travatan, and my eye is noticeably red.  Is that inflammation?

Dr. Elliot Werner:  Travatan causes redness when you first start using it.  There is probably some associated inflammation with the drug.

P:  So just wait it out?

Dr. Elliot Werner:  Yes, in most people the redness diminishes significantly after two or three weeks.

P:  Is it a good idea to let the redness from the Travatan diminish by itself or maybe help it with compresses?

Dr. Elliot Werner:  Compresses will do no harm.  If you get relief, by all means use them.

Moderator:  Sometimes the white of my eye looks bubbled.  Could that be some kind of inflammation?  Sometimes it is red and hurts very much when it looks bubbled.  I have aqueous misdirection syndrome.

Dr. Elliot Werner:  It's hard to diagnose without actually seeing it.  You might be having episcleritis or allergic conjunctivitis.  Both can produce a bubbled appearance associated with redness.  Aqueous misdirection syndrome wouldn't normally cause a bubbled appearance.

P:  Can over a week of inflammation caused by an allergy to Alphagan eyedrops raise IOP and cause damage in the eyes?

Dr. Elliot Werner:  It wouldn't usually cause the IOP to go up, but prolonged use of a drop producing an allergy can cause scarring and damage to the surface of the eye and the eyelids and skin around the eye.

P:  Would the scarring be permanent?  The skin around my eyes was a bit rough shortly after the allergy began.  Would that indicate some damage to the eyes?  I went off Alphagan after eight to ten days and the problem disappeared.  

Dr. Elliot Werner:  If it disappeared, probably not.  But continued use can result in permanent scarring.

P:  Can inflammation from the use of glaucoma eyedrops interfere with the outcome of surgery; for example, a trabeculectomy?

Dr. Elliot Werner:  Yes.  Surface inflammation caused by drug allergy can cause failure of trabeculectomy.

P:  I seem to have had iritis for 20 years or more.  It starts in one eye, but affects both eyes.  It's under control with Predforte.  Is there anything new I could try?

Dr. Elliot Werner:  That depends on the cause.  But you probably had all the tests and no cause was found.  The only thing new in the treatment of chronic or recurrent iritis is cyclosporine, but that is usually reserved for steroid-resistant cases.

P:  I, too, have had uveitis for years, but I believe that I also have choroiditis, which has not been diagnosed.  There are a lot of  vitreous floaters.  How can choroiditis be diagnosed?  We recently heard about Ocular Coherence Tomography (OCT) from Dr. Rick Wilson.  Can you talk about that?

Dr. Elliot Werner:  Most cases of uveitis have no apparent cause.  If no cause is found after extensive testing, the term idiopathic is used.  OCT is a technique for imaging the retina to find certain retinal diseases and monitor the effects of glaucoma.  I don't know of any use for it in uveitis.

P:  My question was about choroiditis. 

Dr. Elliot Werner:  Uveitis is a general term for inflammations involving the uvea.  The uvea consists of three parts, the iris, the ciliary body and the choroid.  Depending on which part of the uvea is inflamed, you may have iritis, cyclitis, or choroiditis.  They are all part of the same condition.

P:  Can OCT confirm choroiditis? 

Dr. Elliot Werner:  Choroiditis is confirmed by looking at the vitreous, retina and choroid with the ophthalmoscope.  OCT is not useful for diagnosing choroiditis, but can be useful in looking for complications of choroiditis.

P:  Can the OCT test show optic nerve damage before you actually lose any sight?  Will it replace the visual field test?

Dr. Elliot Werner:  An excellent question.  OCT can show loss of optic nerve fibers before visual loss develops.  I doubt that it will replace visual field testing, but imaging techniques like OCT, the GDx, and the Heidelberg machine will be a very valuable adjunct.

P:  My iritis is caused by ankylosing spondylitis.  Is that a common cause of chronic iritis?

Dr. Elliot Werner:  Yes, ankylosing spondylitis is a common and well-known cause of chronic iritis and can be very difficult to treat.

P:  Can an inflammation of the sinus elevate IOP or aggravate glaucoma in any way?

Dr. Elliot Werner:  Not directly, but sinus infections can spread to the orbit and the eye and cause problems that way.

P:  Could a sinus infection cause glaucoma?

Dr. Elliot Werner:  Not to my knowledge.

P:  Is there anything on the horizon to treat intraocular inflammation other than steroids and anti-inflammatories?

Dr. Elliot Werner:  Not that I know of, but people are working on safe immunosuppressive drugs.  Maybe someday.

Moderator:  Dr. Werner, thanks so much for your time, attention, and great answers. 

Dr. Elliot Werner:  Thank you.  See you on December 18, and we'll talk about the effect of glaucoma on your life, psyche, and sense of well being.

End of highlights for November 27, 2002.

On December 4, Dr. Wilson discussed "Examining, Grading and Treating the Anterior Chamber Angle" in the Chat room. Click here for highlights of that meeting.

Click here for the most recent glaucoma chat highlights and links to the chat archives.

Click here for upcoming glaucoma chat events.