by Juan Ding, OD, PhD
A 70 year old Asian male complained of eye pain and redness in both eyes, in addition, left ear was swollen and mildly painful, and not hearing too well. He was found to have episcleritis (inflammation of a deeper layer in the white part of the eye) in both eyes and iritis (inflammation of the iris) in the left eye. Combination of these symptoms are suspicious of a condition called relapsing polychondritis (RP). This is an autoimmune disease that targets the cartilage tissue of the body, for example the ear, nose, and the trachea. Eye inflammation can also occur. Since it’s autoimmune in nature, the treatment would be anti-inflammatory, using for example corticosteroids and non-steroidal antiinflammatory drugs (NSAIDs). If necessary, some disease modifying agent such as methotrexate can also be used. He was started on naproxen 500 mg twice daily, as well as an NSAID and steroid eye drops, and his symptoms went away. So in the end he did not need to take methotrexate.
He also had a hx of latent tuberculosis (TB). latent TB means a person has been infected with tuberculosis in the past, but does not show any active sign of disease, such as coughing, fever and night sweats. However, latent TB can cause inflammation in any part of the eye, including the episclera and the iris. So in this case, he is also seeing an infectious disease specialist. Since his eye and ear symptoms resolved on NSAIDs and steroids, it was thought that TB was not the cause, but he was treated with isoniazid for 9 months for latent TB without incidence.
Lastly, although RP frequently causes ears to be red and swollen, it does not typically cause hearing loss. His hearing loss was considered to be another cause. He was treated for 1 month after onset of hearing loss (and ear pain) for a viral etiology with valtrex and prednisone, but did not recover hearing.
So the moral of this case is, if they have inflammation of both eyes and ears, don’t just treat the eye, and think a common underlying etiology.
5 years later, patient came back to see me, his eyes are quiet, as his ears. He does report occasional eye sensation reminiscent of past iritis, but always responds well to the prednisolone drops that he’s instructed to use as needed which he used a few times a month. He is currently not taking any medications for RP and doing well. I asked him to come back in 3 months to check eye pressure and check eye inflammation, and that if a flare up happens come right back. Hopefully the relapsing nature of this disease will not recur.