Blepharitis and keratitis

[adslcfc]

Hi all,

New to the forum, looking forward to reading all your stories and hopefully successes with dry eye!

I have overused my lenses for a couple of years now leading to my eyes becoming very dry, it all came to a head when I left them in for an extended period and it led to a corneal ulcer and keratitis. Anyway I was treated for this in November using antibiotic and steroid drops. This quickly cleared up but once my course finished, within a few days I had inflammation in the same area, went back to the hospital and they said I ha some scarring so I went back on the steroids. Same issue happened again, docs then said I had blepharitis and recommended the lid cleaning. I started this - warm compresses followed by lid scrubs but again the inflammation is back and developed in to mild keratitis again. Now I am on antibiotics but reluctant to use the steroids again as I can't help but think my eye is becoming too reliant on them. Do these symptoms sound like blepharitis and is it normal to keep getting the inflammation? It has never got to the levels as bad as the initial outbreak but im starting to feel like this will never sort itself out. Appreciate and comments guys

Thanks
Adam

[poppy]

If your keratitis is from blepharitis/dry eye, then unfortunately you are probably stuck with it for life. You can only hope to control it. Keratitis caused by dry eye/blepharitis is normally described by docs as punctate keratitis, or abbreviated as SPK. If you have this type of keratitis it is almost certainly chronic, sorry.

[adslcfc]

thanks for the response poppy. I will have a look in to SPK however the multiple ulcerations that are distinct with this is something I have not had, the initial ulcer was the root cause (my own fault for abusing my lenses) and since then I am getting the inflammation when not on steroids.

I have read many people mention that with blepharitis they have a lot of red eye and inflammation too which is why I thought of this.

[adslcfc]

Just a couple of extra bits of info - this is only an issue in one eye which confuses me more! I have a history of psoriasis (although no major outbreak for about 5 years) but do have dry scalp and face - could this contributE?

[littlemermaid]

Adam, If you have chronic MGD, there is a correlation with skin conditions that could be vaguely described as inflammatory, hypersensitive, caused by dysfunctional immunology pathways (psoriasis, eczema, rosacea). These are conditions marked by being responsive to (or, rarely, eg in some rosacea hypersensitivity or acne flare, particularly at site of application or periorificial, caused by... aaargh) steroid, when extreme. Obviously other autoimmune conditions affect these pathways and show in the skin, and thyroid or other hormone dysfunction or imbalances.

Dots on the cornea (superficial punctate keratopathy, or lesions) clear when the eye surface is healthier (LM's come and go). If it's extensive contact lens overwear, your MGs may have packed in, in which case that can be fixed by warm compress and improved diet with omega 3 oils and the antibiotics (if it isn't shifting and the MGs are capped, a last resort might be probing). It's very important to ask an informed ophth to talk about meibom they are seeing (you can have a look yourself) and the state of the glands.

If the eye surface is trashed by contact lens overwear (and I've done this myself), unless there's permanent cell changes I think it will heal (although I'm left with a bit of a permanent dry eye, if I take fish oil the eyes feel great, also supposed to help fix psoriasis). Some think tear sub drops with hyaluronic acid speed up epithelial healing, some don't.

Blephar-itis = eyelids/margins, kerat-itis = cornea, so not quite a diagnosis. The eye surface/tear system is, of course, interdependant, so surface damage may have impeded normal tear response, so you're working on all the components at the same time. Have you got a bland tear-substitute preservative-free dry-eye drop to keep the eye surface safe while everything improves? We use Celluvisc or Hycosan as much as 6/day as needed then reduce when things improve. It would be odd to use steroid without a tear substitute drop after surface damage. This would help keep dry eye inflammation down.

On steroid, altho I can entirely see your point, LM has to use steroid to prevent further damage to control inflammation, plus frequent tear sub drops, till the danger is passed, then weaning off carefully to minimum which is 2/wk for her. It's skill.

Assuming they are sure the ulcer and inflammation was not due to some 'orrible microbial thing from eg contact lenses or solutions. Have they given you topical antibacterials or is it oral antibiotics? or swabbed this?

Sounds like you're slowly spiralling back to health. It's working out what's happened and how to improve things, that's the trick.