Inflammatory Eye Diseases and Immunosuppression

Medical Imaging

The Inflammatory Eye Diseases Service is an internationally acclaimed highly specialised supra-regional service treating a large range of sight-threatening conditions many associated with systemic diseases where the immune system misbehaves. These patients have complex needs and we excel at providing a bespoke, personalised, team based multi-professional approach. This involves direct integration with a panel of experts including rheumatologists, immunologists, renal physicians, dermatologists, oral medicine, clinical psychology and specialist nurse practitioners.

The key areas of expertise focus on severe sight-threatening immune-mediated inflammatory eye diseases involving the ocular surface (the protective layer in front of the eye),  uveitis (inflammation inside the eye) and scleritis (inflammation of the white of the eye). Specifically, we are one of only three National Centres of Excellence for Behçet’s Disease (Hyperlink to webpage) and recognised Quaternary Centre for Ocular Immunobullous Disease and Conjunctival Scarring Disorders such as ocular mucous membrane pemphigoid and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.

We offer a range of highly specialised diagnostic and monitoring strategies such as:

  • Imaging using the latest technologies to look  at the front and inside of the eye (e.g. optical coherencence tomography,      high resolution ultrasound scans, confocal imaging of the ocular surface  and retina), fluorescein dye tests
  • Electrodiagnostic tests to determine the health of the various layers of the retina that are needed for vision.
  • Aqueous and vitreous humour sampling.
  • Corneal, conjunctival and oral mucosal biopsies

We liaise with laboratories that can perform DNA analysis or other specialised tests for the detection of infection and tumours.

Patients are treated in a variety of ways including drops but many of our patients require specialised medications, injections into or around the eye that target the immune system called immunotherapy or immunosuppression. Many of our patients are treated and monitored in the outpatients department but some require day case admission into hospital and others with severe disease may require in-patient stay for specialist cross-disciplinary medical input for the management of their eye disease.

As well as routine cataract surgery, we excel at visual rehabilitation of our highly complex patients with uveitis, scleritis and ocular surface inflammation that may require cataract removal, amniotic membrane grafting, corneal transplantation, and front of the eye reconstructions.

The department is run mainly by the Academic Unit of Ophthalmology clinical consultants and has a world-renowned reputation for research, with several research projects ongoing at any time.  Every patient seen our clinics and every patient admitted under our care has the opportunity to participate in research.

Location:

Birmingham and Midland Eye Centre

City Hospital

Dudley Road

Birmingham

B18 7QH

Team

Inflammatory Eye Disease Consultants:

Professor Philip Murray (Professor of Ophthalmology, University of Birmingham) – special interests include Uveitis, Scleritis and Behçet’s Disease, with research into mechanisms that cause uveitis and teaching.

Miss Saaeha Rauz (Clinical Senior Lecturer, University of Birmingham)– special interests include immune-mediated Ocular Surface Inflammatory Disease, Ocular immunobullous diseases and Scleritis, with research into the immune mechanisms that underlie ocular surface diseases and infections.

Miss Panagiota Stavrou (BMEC)– special interests include Uveitis and Behçet’s.

Mr Alastair Denniston (Queen Elizabeth Hospital, Birmingham and BMEC) – special interests include uveitis and Behçet’s.

Patient Stories

Behçet’s Syndrome  is a multisystem disorder characterised by an occlusive vasculitis which mainly affects young adults. The cause of the syndrome is unknown but can be potentially sight-threatening (blinding).

Birmingham and Midland Eye Centre holds one of the three Behçet’s Centres of excellence in England which allows patients to see clinicians in different specialities with expertise in the management of Behçet’s Syndrome. This means Patients are seen at one location, at the same visit, instead of having to attend numerous hospitals on different days.

Jan Mather shares her Behçet’s Syndrome journey with us…

“My journey with Behçet’s Syndrome probably began as a teenager when I had 3 or 4 bouts of tonsillitis each year, accompanied with what seemed like a constant crop of mouth ulcers.  After several visits to the GP and dentist I was repeatedly told that mouth ulcers are common and most people get them, but most of my friends had one occasionally not a mouth full most of the time!

“Through my early adulthood, I experienced some unexplained episodes of illness including what was suspected to be pleurisy and stomach ulcers but all the tests proved inconclusive and after time, they just disappeared.

“I was very fortunate to be married to John and have our son, Sam before the symptoms of Behçet’s really took hold when he was just two. In a bizarre way, I was fortunate to suffer with a serious complication of Behçet’s in that my eyes started having problems. It started with floaters which look like small black flecks that move about in the eye, then moved on to patches of my eye which were kind of greyed out and I couldn’t see through. I presented at A&E at the Midlands Eye Centre on a Friday evening with the news that they didn’t think there was a particular problem with my eyes, but it was the rest of my body! I received a call from Prof. Murray’s secretary on the Monday morning inviting me to clinic that afternoon where I was diagnosed. By having potentially serious eye involvement and happening to present to one of the leading Ophthalmologists in Behçet’s, I received a very prompt diagnosis which unfortunately is very rare in itself, with the average time to diagnosis being 12 years in the UK.

“Following diagnosis, the Behçet’s really flared for a number of years, initially confining the flares to my eyes. The scariest moment of this journey has got to have been going to bed one evening knowing I was unwell, but waking up the following morning, opening my eyes and just seeing blackness. After checking several times I had actually opened my eyes, it was a swift trip to the Eye Centre where they immediately started a programme of cyclophosphamide and steroids for the next 3 months. I’m pleased to say the vision in one eye was completely restored but the optic nerve was damaged in the other during the flare.

“One of the complications with Behçet’s is that it can affect many parts of the body and my family joke with me that I seem to feel the need to try each area in turn and work my way through all the available tests! So since my diagnosis with my eyes, I’ve also suffered with joint pains, ulcers, headaches, pathergy reactions and ulcers along my bowel and in my genital area in addition to the chronic fatigue that comes with any long term condition. I’ve been in hospital a fair few times and been off work for long periods where I’ve wondered whether I’ll ever feel anywhere like ‘normal’ again.  I’ve sampled a good proportion of the hospital pharmacy in terms of the medication I’ve taken and I’m pleased to say at present I’m stable on Humira which is a self injected anti-TNF medication. Stable doesn’t mean symptom free, which I don’t think anyone with Behçet’s is, but that the symptoms are manageable rather than flaring.

“I consider myself really fortunate though. Nobody would ever choose an incurable illness to suffer with, never mind one that’s rare but I’ve had a great team of consultants managing my care from day one including ophthalmologists, rheumatologists, oral specialists, gynaecologists and occasionally neurologists and gastroenterologists. With the support of this team and my incredible family, I’ve managed to continue working, albeit on a part-time basis.

“When I’d truly accepted that I had this illness which was a few years after diagnosis, and that I needed to reconsider what I could achieve with my life and what was going to be ‘normal’ for me, I got involved with the Behçet’s Syndrome Society which is the UK charity supporting people with this rare, complex and lifelong disease. At first I just helped with fundraising, but eventually became a trustee and have been Chair of the group for the last 6 years. When we discovered the possibility of having Centres of Excellence for Behçet’s, it seemed obvious to me that I wanted others to receive the same high standard of care I’d received in Birmingham and after speaking to Prof Murray and Dr Situnayake, they agreed to work with us through the lengthy application process.

“Having attended the Centre as a patient myself, I’m truly delighted with the patient care. From visiting each of my care team individually which amounted to around 10-12 days per year, I can now be seen by all of the team in one visit. For me, it puts less pressure on my working schedule, but more importantly, it allows a more holistic approach to be taken to patient care with the doctors being able to discuss all the symptoms a patient has rather than just the area they specialise in.

“I’m sure my journey with this condition isn’t over and there will be new challenges to face, but the future for all patients with Behçet’s is so much brighter with these Centres”.

Contacts

Contact details:

Secretary to Ms Rauz – Kate Martin

Tel: 0121 507 6849

 

Secretary to Prof Murray – Jenny Hudson

Tel: 0121 507 6851

 

Secretary to Ms Stavrou – Charlotte Harris

Tel: 0121 507 6854

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