chronic red eye/iritis

I have had a red and unhappy eye for several months.  I have been seeing an ophthalmologist regularly.  I have run thru most dx from conjunctivitis, blepharoconjunctivitis, ? of scarring disease(ruled out) etc.  Also many meds, zylet, restasis, azasite, tobradex.  Now currently off all meds, still the eye remains unhappy.  I am a nurse in a cath lab in the DFW area in Texas.  One of  the cardiologists I work with mentioned the possibility of iritis &/or some sort of autoimmune disorder, so I visited my PCP and had everal of the autoimmune tests performed, ANA, C reactive protein, ESR, RF, Latex etc.  These results are pending.  I have no other symptom other than the unhappy eye.  This happened last year to my eye as well, took about 6 months and several meds, but finally cleared up after being on Tobradex for about  1 1/2 weeks.  Unfortunately, my eye pressure went to 30 with Tobradex and my eye MD will not put me back on this med....I am assuming that if iritis was the problem, that would have been a pretty easy find for the ophthalmologist, he has not suggested this as a diagnosis.  I am sort of grasping at straws here...any suggestions, should I see another eye MD just to get another set of eyes on the problem?  My vision is fairly unaffected at this point, only occasional blurriness that clears with frequent blinking (probably tearing issue per MD), some burning sensation and swelling of the eye.  I am tired of it looking so crappy and just not being "normal".  Kind of shallow I know, but oh well, it's annoying as heck.  I am attaching a picture just to see what you think.  

[John C Hagan III, MD, FACS, FAAO]

Iritis is not that difficult DX to make and its unlikely to be missed. I would suggest a fresh look at your problem by an Eye MD ophthalmologist that specializes in corneal/external diease.   Find one at www.aao.org  or ask around or go to one of the medical centers in town.Likely the automimune work up will be normal

JCH MD

[mandy38]

I had the same thing for a year off and on, more off than on.  It was finally diagnosed as a blocked gland on the bottom lid.  Use a hot flannel morning and night and rub the upper and lower lid gently twenty times, back and forth.  The hotter the better for the face towel.  I saw a significant change in the eye very quickly.  I was also told the pressure in my eye was high and my optic nerve looked suspicious, so I have to have more tests.  I'm just hoping that the steroids I was on have not done the eye some damage!!

[John C Hagan III, MD, FACS, FAAO]

-

[John C Hagan III, MD, FACS, FAAO]

You know I'm not sure I looked at your picture. That is a striking difference and needs worked up as I indicated by a cornea/external disease specialist.

You appear to have a breaking out on your forhead and nose.  In an adult with facial breaking out and red eye(s) one common problem is acne rosecea.

JCH MD

[DS38]

I have been seeing a corneal specialist and have also seen an occuloplastic physician and as I stated my PCP (internest).  I went back this week because the eye was not improving.  They have taken me off of all of  the drops and I am now only on Acyclovir.  I did have a diagnosed herpes infection in 2001, but never a recurrence and this has never appeared to look like herpes over the whole year I have been being treated no dendrites etc.  They told me the cornea is "pristine".  No iritis...just looks like a very chronic conjunctivitis.  (for a year???)  I am schedule to return in 2 weeks with only being on the Acyclovir tablets 400 bid.  Thus far as of day 4, no change and eye is very very red and unimproved.  I have had a rosacea dx in the past but is is mainly on the right side of my face and is now very minimal, could this still be related?  They have not ever mentioned rosacea as a cause...UGH..I am frustrated as you can imagine...I have searched and searched for info about chronic conjunctivitis and conjunctival cancer comes up  or ocular pemphigoid, but I was evaluated by a PhD MD ophthamologist at the medical school for the pemphigoid and he said no way, even though no biopsy was done.  Do you usually have some kind of skin breakout issues on the eyelid if rosacea is the cause?  I don't have that, just the horribly red, swollen ugly eye..Thanks for the info.

[John C Hagan III, MD, FACS, FAAO]

The side of the eye being red and the skin being worse in Roseacea usually are the same but they could be on opposite sides. Phemphigoid is not a difficult diagnosis most times. I do think it important to keep the pedal to the metal until you have a white eye or a definitive diagnosis.

Good luck.

JCH MD