Pinguecula / Pingueculitis treatment

[steveyez]

I am currently suffering in my left eye with inflamed Pinguecula known as Pingueculitis. This has the effect of causing severe itching and gives a constant foreign body sensation which can even interfere with sleep.

It looks like treatment with steroid eye drops is recommended when Pingueculitis occurs but presumably steroid drops cannot be used long term. Surgery to remove Pinguecula looks like it is only done in extreme circumstances as the surgery is not for the squeamish to say the least.

Does anyone have any advice or practical experience of being treated for Pingueculitis ?

I am based in the UK so if anyone can recommend a good consultant then that would be great.

thanks
Steve

[littlemermaid]

Hello Steve,

Have you had the pinguecula assessed by an anterior segment Consultant Ophthalmologist? This is your first step, so s/he can check what's happening or help you think about whether intervention is even needed. Certainly they need to check for infection and control inflammation. It sounds swollen and that you do need specialist help from a doc you like and trust.

I think I would get advice and hospital referral from a high street Optometrist - some of the big chains have some very well-qualified young staff with current training and good standards and equipment.

You're right that they won't intervene with surgery unless it's needed, eg affecting vision, and might want to manage and monitor with eg antibacterials and steroids for a bit if it's inflamed. If it does look like surgery would help I think it's normally an easy day case. I'd be wanting:

- the biggest regional hospital Specialist centre with the best theatre equipment, like imaging in theatre with the microsurgery and pre-surgery imaging like ultrasound, or even a confocal microscope available if there's anything complicated about it eg cornea and lens involved. Also take a good look at the specialist interests of the Ophthalmologists working there through the hospital website.

- a surgeon with lots of experience in pinguecula surgery complications. With a good Registrar backup and vision team available for checkups afterwards. Not someone who's tired from zooming about on rota to different struggling hospital units and isn't comfortable with their operating space and equipment.

- good post-op management on any inflammation, and follow-up check with the backup team if not another look by the Consultant surgeon for infection, eye pressure and vision (amazingly, doesn't always happen after day surgery).

- an anterior segment eye surgeon who has an interest in managing eye surface disorders and dry eye if there are presurgery interventions needed, like stabilising the inflammation on the eye surface according to symptoms rather than just blitzing with steroids and antibacterials.

Any doubts or difficulty in surgery, it could be the national eye hospital, Moorfields, London. All you need is a GP, ophthalmology, optometrist, or other doc NHS referral. That often depends what service they understand is available in the region. Standards are mostly as good in regional Centres, unless it's a quaternary hospital problem, and regional tertiary hospitals can be more personal and more convenient for follow-up. We'd be in the regional Centre for emergency or problems anyway unless you live in SE.

We don't yet have an NHS Specialist Register, tracking and performance data, so we're all still relying on hearsay. But that time will come.

Personally I would choose the NHS, or NHS hospital Private rooms for the assessment if the wait was horrendous, purely for the guarantee, expertise and clinical backup (see regional hospital websites and http://www.drfosterhealth.co.uk/consultant-guide/) (unless I had someone particular in mind who I couldn't access otherwise because I wasn't 'difficult' enough). If there's delay causing problems, it's an option to get a private assessment and NHS surgery http://www.nhs.uk/chq/pages/2572.asp...categoryid=226 If there's any long-term follow-up, we're back in the NHS anyway and it's all about the team and the lead.

Hopefully someone will post up with experience on your actual question, especially about what stage surgery relieved pinguecula versus drops. What do you think? How's it going?

[steveyez]

Thanks LittleMermaid - the level of information you have provided is amazing, very helpful and a lot of it is completely new information to me.

I am based in the Midlands and have enquired and researched around this subject and have been recommended a respected NHS consultant based in the West Midlands who I am arranging an appointment to see for a consultation soon.

There does not seem to be a lot of precise information on Pinguecula / Pingueculitis so any details I find out I will post to try and help others

[littlemermaid]

Thank you, Steveyez ~ we are all in the same boat here and any information sharing is most helpful for everyone. Very good news you've got a specialist Ophthalmology appointment. We always feel happier and better informed with professionals on the job, with a jolly good backup team.

[steveyez]

This looks a very interesting development - Pterygium Nonsurgical Treatment Using Topical Dipyridamole

http://www.karger.com/Article/FullText/362113