MRSA Conjunctivitis?

Hi,

On June 24th I went to see a local Internest for Conjunctivitis, and was prescribed Genoptic drops to treat my infection. The Genoptic did not resolve the infection after a full course of treatment.

Subsequent to that, I saw a local Optometrist on July 13th who prescribed Vigamox to get rid of the infection. That was 5 days ago. While I have seen some improvement, it still really isn't resolving, in fact I had some more discharge yesterday morning and my eye was partially stuck shut again upon awakening.

I'm starting to wonder if perhaps it's a resistant strain of Staph. I think its fairly well documented that there is a lot of Staph out there that is quinolone resistant.

I had an ID doc suggest trying a sulfa based drug since the Staph resistance isn't so high.

If the Vigamox doesn't resolve it within the next few days, what should be my next step? Get it swabbed and cultured to see what we are dealing with here?

We've had a fair amount of C-MSRA infections here in my community over the last two years, and it makes me wonder. I really figured the Vigamox would do the trick.

Thanks!

[EyeMD]

You should have an eye exam by an ophthalmologist. There are certain signs one can look for to see if conjunctivitis is more likely to be bacterial, viral or neither.

If the conjunctivitis looks like it is infectious you really need to have a culture done for viruses, bacteria and chlamydia.

Bacterial conjunctivitis is rare in adults (<5%). The more likely things are viral conjunctivitis (especially if you are around kids, or have recently had a cough,cold, sore throat) or dry eye (including blepharitis - inflammation of the eye lids).

Not uncommonly, people are started on aggressive topical treatment for a supposed bacterial conjunctivitis and end up with a toxic conjunctivitis from the medications. These drops are then switched (because they are clearly not working) for other more potent drops, which then compound the issue. In these cases, stopping the medicated drops and switching to preservative-free artificial tears can greatly improve the situation.

Hope that helps!

[Ray T Oyakawa, MD]

Cultures are rarely done in practice due a number of factors including cost.  Most case resolve with antbiotics.  As mentioned by EyeMD, most are viral.

Dr. O.

[wyo327]

Guys, thanks!

Two things I guess.

It's unilateral with brown/yellow discharge that sticks the eye shut. Is this seen with the viral form?

It actually got worse between dx'ing the Genoptic and starting the Vigamox in terms of the 'gunk' and the eyelid being stuck shut in the AM.

Also, I had a dental procedure done the middle of last month that involved some drilling along with water lavage and got splashed in the eye several times before the Dentist told me to close my eye. It wasn't too long after that that this all started.

Thank you!