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Q. What are the treatments available for my husband's eye problem?

Answered by Dr. Asif Manzoor.


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Image: What are the treatments available for my husband's eye problem?

Hi doctor,

My husband is a contact lens wearer for more than 15 years. He changed the contact lens brand as per optometrist advise. Within a week, he started rubbing the eyes and got a point of laceration and then infection in the right eye. The infection also has spread to the other eye. Six months later, he has lost all feeling in the right eye. There is a large nonhealing ulcer in the right eye. Both eyes become hazy. He described it as looking through a wax paper. Most doctors he has seen will not dilate his eyes as they say they will not be able to see in. He says his vision is worse when he first wakes up. He has halos, light sensitivity, headaches and eye pain. Glasses do not help and contact lens has not been used since the beginning of this issue.

He was diagnosed to have dry eyes, by a cornea specialist, but he did not perform a tear production test. Another cornea specialists without doing a tear test said that his eyes have only slightly less tear production. But, retina specialist said that everything is normal and it is a cornea problem. With six months of Restasis, Besivance and Lotemax, there is no improvement. He cannot drive, cook, read, watch television, work, play with our son or pour himself a glass of soda. He has tried pressure patches. The doctors advised to get an AMG on his left eye under a new BCL. Currently, there is no active infection in the left eye. The right eye is much worse with a large visible ulcer and looks very whitish and yellowish.

Dry eyes seem absurd at this point. What other treatments are available? What are the other possible diagnosis? I know you cannot say for sure, but an idea would be great. He feel taking the trash out tonight as he could not see. He lacerated his nose, lips, both his shins and has a bruise on his entire inside arm. He is depressed and I am at a loss. He needs help walking down the street as he cannot see. He is just 39 years old. His health is generally good. The most worrisome part is that his left eye is catching up with the right. I believe that the vision test was 500/20 and 300/20 last week.


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Dr. Asif Manzoor
M.B.B.S., MRCS EDIN. OPHTHALMOLOGY., FCPS OPHTHALMOLOGY
Ophthalmology (Eye Care

Hi,

Welcome to icliniq.com.

  • From the history you described and the prescription attached (attachment removed to protect patient identity), the corneal ulcer in both eyes after contact lens wear may be due to contact lens infection, infected lens solution or trauma during wearing or removing.
  • But, it is less likely that trauma on both sides and most probably it was due to infection.
  • With contact lenses different types of infections can occur like pseudomonas, acanthamoeba infection, etc. In acanthamoeba ulcer, there is severe unbearable pain in eyes.
  • Actually, that is confirmed on culture and sensitivity test. You have not mentioned any culture and sensitivity report as which organism was found as the causative agent. After the report, specific drugs are used as that are sensitive for that organism.
  • Initial treatment is usually broad spectrum antibiotic and according to culture. Cycloplegics are given to relief pain and lubricants are also supportive.
  • Your eye doctor would be treating it properly. Some other modalities can be done to improve corneal ulcer healing and that also depends on the current situation.
  • Once ulcer and infection is controlled, then long-term drops are used and then there may be an option of keratoplasty if donor cornea is available.
  • Visual improvement may be expected after keratoplasty, but there are also some considerations for keratoplasty. So, I would advise you to follow your eye doctor as he is doing a great job.

Revert back with the culture reports to an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

 
 
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