Corneal ulcer/infection

[topcat172]

I have a corneal ulcer/infection being treated with fortified antibiotics(Vancomycin and Tobramycin) 1 drop every hour, vigamox 4xday, tobradex ointment 1at bedtime, and predforte 4xday. I have been using these medications since Friday Oct.31 Saw Dr. Nov.1st and was told to stay on this schedule. I saw my glaucoma specialist today and he took me off all meds except fortified antibiotics. I was told even though my symptoms appear better the ulcer/infection is not any better than it was on 1st day. How long does it normally take for these ulcers and infections to heal? i need a trabeculectomy in right eye but it has to be postponed until left eye is resolved. I had light perception only vision in left eye due to endophthalmitis and now can't even see light.Was told I have lost 40% of vision in right eye due to pigmentary glaucoma and right eye has already been treated with slt and maximum medical therapy. Need to get ulcer resolved quickly.
Thanks!

[Michael J Kutryb, MD]

I am sorry but you have a very major problem going on right now.  Please carefully follow the directions of your ophthalmologist.  There is no easy solution to this problem and it make take a long time to improve (and it is just one of many very serious problems you have.)  How did you get a corneal ulcer after all you have been through with endophthalmitis?

MJK MD

[topcat172]

I have been given different reasons for the corneal ulcer. The retina specialist seems to think I may have an auto-immune problem of some sort. My primary ophthamologist says it is due to a sub-tenons kenalog injection given by the retina specialist approx. 2 weeks before the ulcer developed. The ophthamologist I see when primary is out (same group) seems to agree with retina specialist.My primary care physician has ordered lots of lab work to see if there is another problem. I saw primary ophthamologist Friday and he was upset with the medications the retina specialist and other ophthamologist had me using and discontinued all but the 2 fortified antibiotics. I saw the opthamologist (not primary) today and he was upset primary had discontinued some of the meds. He said there were "too many cooks in the kitchen" I go to my appointments and do what that particular doctor says because I do not know what else to do. They are in contact with each other but have differing ideas about causes and treatment options. I have tried to see other MD's in my area but after they look at my medical records they do not want to get involved because of all of the problems I have had. Other than having to wear glasses, I never had any problems with my eyes until the cataract surgery in my left eye. I did have pigment dispersia syndrome but it did not develop into pigmentary glaucoma after I had angle closure due to pupillary block caused by iol implant. I have been told by one of the ophthamologists to "get over it and learn to deal with it." I have not actually  gotten over it but I have adapted well and I think I have handled the whole situation exceptionally well.Ulcer today had went from 3mmx2mm to 3mmx1.8. Hypopyon is still there but improving. I was told to stay on the 2 fortified antibiotics 1 drop every hour and that is what I am doing. Thanks so much for answering my questions. You have always been very helpful and I appreciate it very much. You area very kind man!
Thanks and God bless you!

[Sandy Feldman, MD, MS]

Dear topcat172,

It is important to make sure that the infection is fully treatment before intraocular surgery is performed.  The length of time to resolution of the ulcer may vary with the type of organism and extent of infection.  Make sure you see your eyeMD frequently and follow the regimen of drops.  It may resolve in one week or it can take longer, depending on the causative agent.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California