Eye swelled last night after bacitracin What do I do as doctor is out?

[mkh9]

Hi, my corneal specialist (opthamologist) said I have a marginal corneal ulcer bacterial in nature and was thought be caused by rosacea. He gave me Vigamox drops every two hours and Bacitracin ointment for night time. I am having a lot of side effects from the Vigamox (irritation, watery eye, itcy, pain etc. and very red eye). But that is not the biggest problem. I tried the Bacitracin for two nights. Last night I up and saw that my eye was very swollen. I called the on call doctor since it is the weekend and she said she can't write me any new prescriptions because she is not my doctor and said to just use GenTeal ointment (petrolatum) at night. But I am afraid to not use an antibiotic at night due to the nature of the corneal ulcer. Do you think it is safe to not use any antibiotic at night. The Corneal specialist said that it would two antibiotics to clear it up. I don't know what to do. Any advice would help.
mkh9

[JohnHaganMD]

A marginal cornea ulcer in the standard sense is not an aggressive ulcer and often non-infected and due to an anti-body/antigen reaction (hypersensitivity). If the bacitracin is clearly making your eye red, swollen and the skin looking scaled then you should likely follow the doctor on call's advice and stop it. As for the vigamox I suggest you call the doctor on call back and review the whole situation It might even be a different more accommodating physician that would make a change over the phone.  

[mkh9]

The corneal specialist said it was bacterial and due to blepheritis and also rosacea. That is why I'm on both. But the on call doctor said she can't change the corneal specialist's treatment. I am seeing again on Monday. If you think that it won't progress that fast so that I can get some sleep I will continue the Vigamox during the day and the gel at night. I asked the corrneal specialist if the antibiotics would clear this up. He said with both antibiotics. That is why I am worried. But he didn't do a culture or anything. He did say that the blepheritis was an immune response at this point. Previous to that I saw a urgent care doctor (not opthamologist) he looked at it with fluorcein and it was negative for herpetic dentrites). So that is good. But he only gave me the Vigamox 4 x a day . The corneal specialist said that that was wrong it should be every two hours. So  I am doing that. But it is harsh. My eye is watering , red and itchy. But it is the side effects of Vigamox.  I just want to do the right thing. Every thing I have read says to treat this agressively. So, I don't want to lose my vision. I  am very scared.
mkh9

[mkh9]

p.s. bacterial in that I think that it is a bacterial overgrowth probably due to the blepheritis. I don't really know for sure what exactly caused this. I go to the gym 4 x a week too and the eye has been having goo in it for several weeks.
mkh9

[JohnHaganMD]

I cannot make those judgments on the internet. And the on call doctor is not being forthwith. He/she can change the orders if indicated. If necessary the on call doctor should see you and examine the eye. That's why they are on call. I have spent 40 years going in at night and on week ends to see my and other doctors patients.

[JohnHaganMD]

Here is a review you can read:  https://www.reviewofophthalmology.com/article/marginal-infiltrates-a-mysterious-malady  

[mkh9]

Thank you! You are very kind.
mkh9

[JohnHaganMD]

Yes and you have not been treated well by the on call doctor. I would complain when you see your regular doctor on Monday.

[mkh9]

I agree. My eye swelled more today even though I went off of the Bacitracin. But it may be hypersensitivity that will take a steroid or time to go away. I am hypersensitive to a lot of topicals. I need to get patch tested. I can either see my family practice doctor if I can get in today as they have an on call doctor you can see or I can stay the course with the vigamox until tomorrow. Now sure which is best. They have limited things they can do I think.
mkh9

[mkh9]

well, the on call clinic is booked. That is San Diego for you. LOL

[mkh9]

Update. I called again to the opthamologist after hours line today. I got a different doctor and he was great. He took a detailed history online and then said that I could come in if I wanted to but it didn't sound like an emergency. He things it is a hypersensitivity to the Bacitracin and that I can continue the Vigamox but do it every 3 hours instead and then wait 15min and rinse with preservative free eye drops. He said I could call him any time today if it gets worse or need to come in. I think I may switch to this person. He listened very well. Nice guy.
I feel so much better with someone that will actually listen.
thanks again for your help.
mkh9

[JohnHaganMD]

An ounce of kindness and concern goes a long way especially when dealing with after hours problems.

[mkh9]

Another update and question if you can. So, I went off the Bacitracin. Went back to the corneal specialist M.D.and he said the ulcer was healed over but to continue using the Vigamox drops every 3 hours as the other opthamologist said and add Lotemax steroid drops 0.5% 2X a day for 1week then 1 time a day for a week to taper. Also at night to use Azasite 1% eye drops at bedtime to tide me over so I don't have to get up. So I have been fine with this treatment and the ulcer area has diminished to hardly visible. I am on the 4th day of the tapering of the steroid (second week). So my eyes are brown and today I noticed a dark brown spot in the colored area (Iris) part of the eye. I can't tell if it is on the cornea or beneath it. It looks beneath it. It is like a pigmentation. It wasn't there before. I called the office and it is Friday at 2:30 and they say the nurse will call back and the doctor can't see me. He is leaving in an hour. It has been an hour and I haven't heard back of course as they don't answer their calls. I am stressed. I have no symptoms (no pain, irritation, swelling anything) other than the dark spot that appeared. Do you have any idea what this is? I wonder if it is from the steroid? I guess I should continue the meds until Monday when I see him unless it changes or gets worse.

thanks,
mkh9

[mkh9]

I figured out what the dark spot is. I feed dumb. It is a shadow from the scarring of the corneal ulcer because when you shine the light on it at a different angle than directly on it it goes away. So it is on the cornea and the shadow appears to look like it is on the iris. So, it is nothing to worry about. At least We figured it out. I hope the scarring goes away. I will ask about this on Monday when I see the doctor.
thanks,
mkh9

[JohnHaganMD]

Good work. Don't forget to send yourself a bill for the great diagnosis and treatment.

[mkh9]

Thanks! That is funny. I wish I got paid for my microbiology work. I need a job. LOL. My husband is great at troubleshooting, at a diagnostic biotech. He fixes all their problems too. I hope I can figure out how not to get another eye problem. I  am afraid of that. It is really stressing me out. I have rosacea but I think I am allergic to Tetracycline. I have to get tested to be sure. I use Finacea topical for it. But I was using Neutrogena oil free makeup remover and a cotton square to rub off my eyeliner before this all happened and scrubbed more vigorously than usual to get it off (with the eye closed). I saw the corneal ulcer later that day. So I don't know which caused it. It is depressing to me as a women to not be able to wear makeup and also fear getting this back possibly due to either removing the makeup or having rosacea and not really knowing what the cause is. I think it was from removing the eye makeup. But obviously I have a blepheritis problem that wasn't being paid attention to enough. The one thing that is a problem is I started Trokendi (for migraine maintenance. Actually for severe vertigo due to the migraine). After that I got dry eyes, dry mouth, dry skin, the blepheritis etc. so I hope that if I go down on the medication since I am stable everything will get better. But I also don't want to fall over. It is a catch 22. I am very frustrated and don't know who to go to first.
mkh9

[JohnHaganMD]

Well you have handful of chronic disease.  For the acne roseacea need to work to keep it off eyelids and out of eyes. Try Ocusoft Plus Platinum wipes and foam for removing makeup and oil from your lids. If not available in store can order on internet it is not a prescription medication. Removing the oil on the eyelid margin will help reduce risk of another marginal corneal ulcer.

[mkh9]

Thanks. Right now I am using eye lid wipes. Those helps. I was also heating them with a wash cloth once a day at night and wiping with baby shampoo. But I got a Meibomian gland clogged and won't go away and so now I am stuck with that too. So, the corneal doctor said that will never go away. Is that true? I can try to heat it several times  a day but it has been there for months. So I hear there are eye drops with lipids in them. Would these be helpful and can you use them during the day? Giving this situation how many times a day should I use the Occusoft Plus Platinum wipes and foam? Is twice  a day good enough? I think I will then try to see either a dermatologist or a allergist next. Very frustrated.
mkh9

[JohnHaganMD]

It is a chronic problem so you need to learn how to help.  You can also use the reheatable eye pads that are inexpensive and you get at drug store and warm in microwave. Twice/day is fine. The dermatologist can help with acne roseacea.  I doubt the allergist will be very helpful.   Here is link to some new treatments such as lipiflow:  https://www.aao.org/eyenet/article/managing-blepharitis-tried-true-new-approaches

[mkh9]

Thanks for the information. I'll check into it. As for the allergist. I want to find out if I am truly allergic or have a delayed hypersensitivity to tetracycline or its derivatives. If not I could possibly use it for treatment of rosacea in addition to the Finacea.

Kind regards,
mkh9

[JohnHaganMD]

Best of luck