Persistant SPK... Help!!!

[ODhopeful]

Had a patient that wears heavy eye makeup coming in for CL exam with grade 3 SPK OU. BVA 20/40+ OD & OS. Put her on Tobradex q3h x 3 days, then qid 4 days and also Erythromycin ointment at night plus no CL wear as well as AT q2h while awake. At the one week f/u she showed minor, but almost insignificant improvement. Decided to switch to Vigamox qid instead of Tobradex due to possible delayed healing from the steroid, then RTC 1 week. I also asked her to switch eye makeup brand. My question is what could I do next if she doesn't show marked improvement at her next f/u? Any suggestion would be great. BTW she doesn't report any drug sensitivity. Thanks

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[KHE]

Had a patient that wears heavy eye makeup coming in for CL exam with grade 3 SPK OU. BVA 20/40+ OD & OS. Put her on Tobradex q3h x 3 days, then qid 4 days and also Erythromycin ointment at night plus no CL wear as well as AT q2h while awake. At the one week f/u she showed minor, but almost insignificant improvement. Decided to switch to Vigamox qid instead of Tobradex due to possible delayed healing from the steroid, then RTC 1 week. I also asked her to switch eye makeup brand. My question is what could I do next if she doesn't show marked improvement at her next f/u? Any suggestion would be great. BTW she doesn't report any drug sensitivity. Thanks

Patients usually hate to hear this but for recalcitrant cases, particularly in CL wearers the only thing that works is non preserved artificial tears QID and no CLs for a month.

Also, you seem to be severely over medicating this patient with anti biotics. If there's no active infection going on, then you don't need that much coverage.

 

[WoodyJI]

I agree, many of the antibiotic classes have the possibility of corneal toxicity when used long-term, especially the aminoglycosides. Perhaps the patient would be receptive to a bland ointment qhs?

 

[Commando303]

Had a patient that wears heavy eye makeup coming in for CL exam with grade 3 SPK OU. BVA 20/40+ OD & OS. Put her on Tobradex q3h x 3 days, then qid 4 days and also Erythromycin ointment at night plus no CL wear as well as AT q2h while awake. At the one week f/u she showed minor, but almost insignificant improvement. Decided to switch to Vigamox qid instead of Tobradex due to possible delayed healing from the steroid, then RTC 1 week. I also asked her to switch eye makeup brand. My question is what could I do next if she doesn't show marked improvement at her next f/u? Any suggestion would be great. BTW she doesn't report any drug sensitivity. Thanks

Discontinue wear of contact lenses and of eye make-up; preservative-free lubrication Q.I.D.; follow up in one week.

*Realizing this thread is not new. Don't care — ...bored.

 

[thiaeyemd]

Had a patient that wears heavy eye makeup coming in for CL exam with grade 3 SPK OU. BVA 20/40+ OD & OS. Put her on Tobradex q3h x 3 days, then qid 4 days and also Erythromycin ointment at night plus no CL wear as well as AT q2h while awake. At the one week f/u she showed minor, but almost insignificant improvement. Decided to switch to Vigamox qid instead of Tobradex due to possible delayed healing from the steroid, then RTC 1 week. I also asked her to switch eye makeup brand. My question is what could I do next if she doesn't show marked improvement at her next f/u? Any suggestion would be great. BTW she doesn't report any drug sensitivity. Thanks

Not clear why for SPK you started a steroid/antibiotic or even used Vigamox at all unless there was a clear infection. Totally agree with the rest of the crew here to use artificial tear drops alone. The vigamox and tobradex probably contributed to more bacterial antibiotic resistance in the world.

 

[fjpod]

Sounds like a lot of medication to me.

I find most cases of CL related SPK have to do with CL issues. CL issues like poor fit, not rinsing and rubbing lenses before storage overnight, poor case hygiene, case topping off, using store brand multi-purpose solutions (and even name brands sometimes), overwear, not following lens replacement schedules, etc.

You have to fix the problem, not just medicate. Refitting with a daily replacement lens may be an answer.

 

[RadixLuminogen]

Not clear why for SPK you started a steroid/antibiotic or even used Vigamox at all unless there was a clear infection. Totally agree with the rest of the crew here to use artificial tear drops alone. The vigamox and tobradex probably contributed to more bacterial antibiotic resistance in the world.

Agree, people love to throw fourth generation fluoroquinolones at non-infectious lesions or even for post-intravitreal injections. Well hey at least the pharmaceutical companies will keep making money by developing new drugs.

 

[doofy]

How come no one suggested punctual plugs?