Uveitis- Story of a Blind Man
It was last week of March. A young man with white stick entered my chamber with the help of another young man & women. The woman was his sister and the young man was his brother in law. The blind man was Saiful aged 35. I have some experience in low vision. I have to face this type of patients frequently. Only a blind man can feel what is the real darkness and how much painful it is. As an ophthalmologist we can feel how eagerly they wait to have some vision knowing it is an irreversible issue.
Saiful is a special case for me. He lives in Chatulia of Shingheshwar union in Phulpur upozila of Mymensingh district. It is about 5/6 km from my village home. As I can remember it is around 1996 or 1997 I found Saiful in FCPS examination hall where I supposed to assist my Professor regarding case selection and arrangement in the hall.
Saiful had to face redness with pain in one or other eye following blurring of vision and sometime swelling of lids. The complaints were used to subside with treatment. After few years he experienced that frequency of attacks was increasing. Eventually he found that each attack resulting some residual haziness. He used to take topical medication, sometime oral steroid preparation even sometime steroid injection in his eyes. He was frequently changed the specialist and Hospital according to advice of his specialist and sometime his relatives even other patients he used to meet in different hospitals or chambers. His principal concern was the recurrence of the episode with residual haziness. Saiful was suffering from chronic uveitis.
What is uveitis ?
Uveitis is the inflammation of the uvea, the middle vascular coat of the eyeball. Uvea consists of three parts anterior to posterior are iris, ciliary body and choroid. The common causes of uveitis are bacteria, virus, fungus, trauma and autoimmune diseases. Autoimmune causes more relevant with chronic uveitis are VKH, Behchet’s disease, ankylosing spondylitis, juvenile rheumatoid arthritis, psoriasis etc.
Complications of chronic uveitis-
Main blinding concerns are cataract formation and retinal detachment. Inflammation for long duration change the microenvironment of the natural lens in the eye causing opacification of the lens means cataract. Another consequence of chronic inflammation is collection of fluids within the retina the neural inner coat of the eyeball which become splitted means retinal detachment. The third important feature is retinitis that is inflammation of retinal tissue either due to direct invasion or toxic cause may result the blindness.
Saiful had developed all the complications. Initially he developed cataract, vitritis, retinitis and subsequently retinal detachment. All these complications were gradually established even with treatment he was provided for years together. At that time cataract was manageable but retinal detachment was beyond his reach. As Saiful was a poor man it was not possible for him to take treatment abroad. With the passing of years density of haziness was increasing. Saiful was very anxious about the deterioration of his vision. I was more or less in touch of his treatment all along. At one stage he was realizing that without any dramatic response of the treatment he will become blind. He used to enquire whether it was possible to preserve the residual vision. It was really an embarrassing situation for both doctor and patient. Both were realizing that Saiful will be blind in near future. Both were in constrain; One in his limitation of expertise and another one in shortage of enough money to have treatment abroad. Ultimately in 2005 Saiful lost light perception in his eyes and become a blind man.
After a long gap I found saiful again in my village house Imadpur in Phulpur Upozila of Mymensingh district where I used to attend 1st Friday of every month to pursue a charity (health camp) conducted by ‘ Amzad Ali Memorial foundation’. Now he is a bearded man. He is calm and quiet. It is very embarrassing to deal with a blind man regarding his treatment. Saiful wanted to know about the latest treatment which can help him. Whether corneal transplant would make any help ? I tried to make him understand about the reality. Finally he opened the main story that is purpose of his visit. Recently he started a new treatment regime that was some sorts of heat therapy according to saiful. But there was no relevant paper with him. Though I knew that there was no hope still I could not reply him negatively on spot. I asked him to bring the relevant papers in next visit. Saiful had come to me that evening with those papers along with a small device. The device was 6 inch long, 1 inch in width and height with button and round tip. On pushing the button the head begin to rotate fast. It has to use around eyeball softly and provide heat and message. He was also advised to take carrot frequently. He was hopeful initially but later become frustrated. He wanted to know whether the therapy would help him any way. I could not give him any hope.
Saiful left my chamber. I was cool and tried to imagine the future of the young man. But next patient intercepted me and I became engaged with the new case.
The vacant face of Saiful left a big question, why there is preventable blindness in the society? Does it mean it is the inaction of doctors or society or patient? Who will answer these?
Dr. Md. Sayedul HoqueMBBS, FCPS, MS (ophth) National Eye Care Centre Ring Road, Shyamoli, Dhaka. Ex-Associate Professor National Institute of Ophthalmology & Hospital