Glaucoma, Uveitis, Laser Iridotomy advice

February 13, 2025 3:17 PM

I'm seeking advice about some eye conditions. I'll briefly define them, in case it jogs an anecdote. Narrow Angles: when the eyeball's internal drainage area is small, increasing the risk of blockage, aka Angle Closure Glaucoma: a vision threatening emergency where a fluid blockage increases eye pressure. One preventative strategy is Laser Iridotomy: burning a small hole in the iris to create a new permanent drainage channel inside the eye. But this may trigger Uveitis, a persistent internal eye inflammation that may have an autoimmune or genetic component. If you know anything about this topic, I have questions!

Angle closure glaucoma runs in my family, and I have all the risk factors, although luckily I've never had a pressure attack.

My aunt and my first cousin have both had laser iridotomies for their narrow angles. My aunt's went well, but my cousin developed chronic uveitis which has made her vision so blurry and light-sensitive that she's now unable to drive - a terrible outcome for an elective preventative surgery. She says she discovered that she has a genetic predisposition to uveitis, which should have been predictable because of her chronic autoimmune issues (allergies, psoriasis, and arthritis). And apparently there's a genetic test she could have done. But her knowledge of the genetic and autoimmune aspects was fuzzy.

My optometrist wasn't familiar with my cousin's points about predicting uveitis, but said that if he were in my shoes, he would get the iridotomy surgery. I'm on a wait list for an opthalmologist appointment. Meanwhile, the prospect of eye surgery makes me nervous.

Does anyone have advice, anecdotes, or research tips to help me track down this genetic test for uveitis. Or any thoughts to help me decide whether or not to have the surgery. And if I do get the iridotomy, any reassurance or tips to make sure it goes well.

posted by vanilla.extract to Health & Fitness (5 answers total)

Are you near, or can you consult with, someplace like Bascom Palmer Eye Institute or Wills Eye Hospital? At the least, perhaps someone at one of these places can help with your genetic test question. Here's a list.
posted by gudrun at 3:50 PM on February 13 [1 favorite]

Hi! I have idiopathic glaucomatic uveitis. In my case, the uveitis is what triggered synechiae (Scarring) in my eye to make my angle very narrow. It also changed the shape of my pupil. However, I didn't even have symptoms of the inflammation. I suddenly developed "scintillating scotoma" and when I went to the optho, he asked if I had ever been in a car accident or punched in the eye. I was shocked because no, I had never had any trauma to the eye. So something was inflaming and scarring the inside of my eye and I had no symptoms at all. I'm kind of doubtful that the iridotomy "caused" the uveitis for your cousin. It may have just brought it to the surface.

You can get tested for HLAB27 gene, but even if you are positive, it doesn't change anything. You are at much greater risk of harm from a pressure attack than maybe getting uveitis.
posted by marvelousmellitus at 4:00 PM on February 13 [2 favorites]

Do you have other chronic autoimmune issues? You could maybe consider going to a rheumatologist to talk about this question as I believe they're the most familiar with the constellation of autoimmune stuff that can include uveitis susceptibility.

My husband has had uveitis "flares" typically caused by stress or consuming alcohol. Honestly, since he quit drinking it has not really been an issue for him. But I'd say that in my experience at least, it seems like uveitis is one of those "sometimes your body part just gets mad" things. Sure you can maybe predict higher susceptibility, you can maybe blame genetics or trauma, but sometimes your eye is just gonna develop uveitis.
posted by potrzebie at 4:14 PM on February 13

HLAB27 is a genetic marker for some of the autoinflammatory conditions associated with uveitis. But it’s just an association—I am negative for the gene but have one of the conditions and a history of uveitis. So if you are HLAB27 positive, you are at higher risk, but if you’re negative, there’s still no guarantees. Talk to a rheumatologist for sure.
posted by hydropsyche at 7:04 AM on February 14 [1 favorite]

I had Iridotomy for Narrow Angles a couple of months ago which resulted in uveitis. My Opthomologist put on on a course of "step-up/step-down" eye drops for 3 weeks following the immediate treatment: every 2 hours for 5 days, every 3 hours for 5 days, etc. It has now been several week without the drops, and I no longer have symptoms. I guess mine was acute rather than chronic uveitis, but maybe the treatment helped to avoid it becoming a chronic issue. So, perhaps talk with your Opthamologist about a preventive course of "setp-up/step-down" drops following the procedure.
posted by Pineapplicious at 7:26 AM on February 14 [1 favorite]