My recurring eye problem is flaring up yet again
DEAR DR. GOTT: I am having yet another bout of iritis, with accompanying pain and sensitivity to light. This always seems to happen when I am away from home and cannot see my own doctor. I have been treated with steroid eye drops in the past but wonder if there is anything you can recommend instead.
DEAR READER: Uveitis is inflammation and swelling of the uvea, the layer of the eye between the retina and sclera. One of the most common forms is anterior uveitis, which involves the front portion of the eye and is limited to the iris — thus, the name iritis.
Most attacks are mild. Symptoms last from a few days to several weeks with treatment, and the bouts are prone to recurrence.
Common symptoms are pain, swelling, tearing and photophobia (light sensitivity). Severe cases can include blurred vision. The condition can affect one or both eyes and is most common in young and middle-aged people. Upon examination, the pupil is constricted, the iris bulges, and the eye appears cloudy.
Steroid eye drops or ointments are often used to treat the inflammation. Severe cases that recur regularly are best handled by a thorough search for the underlying cause. Without this information, I cannot specifically answer which treatment is best for you.
There are several other forms of uveitis that appear to be associated with Crohn's disease, systemic infection, toxoplasmosis, trauma, rheumatoid arthritis, autoimmune disorders and more.
Return to your physician, who can take a complete history and determine whether the steroid drops are appropriate. Should you be suffering from an infection, treatment might include an antibiotic. Finding the underlying cause is the best approach.
DEAR DR. GOTT: I must inform you that twice recently you recognized that a dental consultation was needed, except you said orthodontist when the problem had nothing to do with moving teeth. These patients needed a good general dentist, not an orthodontist.
DEAR READER: I stubbed my toe. Twice!
The dental field is an extremely specialized one. For example, an endodontist specializes in matters concerning the pulp or inside of the tooth and would be consulted when that portion is infected or inflamed, or if a root canal is required.
A periodontist is trained in diagnosing, preventing and treating gum disease. One might be consulted for dental implants, or to perform cosmetic periodontal treatment.
A prosthodontist is trained to deal with missing teeth, restoration of natural teeth and restoration of the whole mouth. A specialist in this field would be consulted for dentures, implants and fixed bridges.
Oral and maxillofacial surgeons manage defects and injuries of the mouth, teeth, jaw and face. Their demanding residency includes rotation through many fields to include general surgery, otolaryngology, plastic surgery, emergency medicine, internal medicine and more.
Let's not forget the general dentist on the corner, the pediatric dentist and all the additional fields I haven't covered. There's an old expression that says "A doctor is a doctor is a doctor." In the field of dentistry, that saying just doesn't cut it. I'll be more careful in the future. Thanks for picking me up on such an important issue.