long term Vexol use for thygesons

For about 1.5 years I have had recurrent bouts of Thygeson superficial punctate keratitis (diagnosed by opthalmologist) in my left eye (right eye has remained clear). I am a 41 year old female, otherwise healthy, nonsmoker, weight at low end of healthy range. Eyesight is slightly shortsighted (-1, -2) with slight astigmatism. Never worn contacts; wear glasses for distance and driving.
I have been prescribed Vexol which I understand is lowish risk for causing pressure spikes and cataracts. During a flare-up, my prescription has been one drop Vexol 3 times per day for 1 week, then 2 per day for 3 days, then 1 per day for 3 days. Vexol clears the redness within one day, and at the end of 2 weeks when I have the IOP checked, I am usually told the lesions have gone. Flare-ups have been occuring increasingly frequently - during the last one, the opthalmologist had me use 1 drop Vexol per day for 2 MONTHS to see if that would stop it. At the end of this time I was given the 'all clear', but within one week of stopping, the redness came back - it felt worse than ever. Is it possible to have 'steroid rebound' from Vexol? i.e. if I 'toughed it out' for a few weeks, could the eye clear up? My understanding is that the disease eventually burns itself out with minimal long term damage, even if not treated - but it's very hard to bear it with no relief (I get migraines on my left side which are worse and more frequent during a thygeson episode).
I am concerned to use Vexol practically continuously for a long time even though it's one of the better steroid options. I was told I have very small 'bits of cataract' in both eyes (which have not changed over the year I've been being treated, so the opthal suspects they are congenital, but there's a risk they will be 'activated' by steroid treatment). Restasis is not an option for treatment in the country in which I live.
any advice on how to deal with this would be greatly appreciated. thanks very much in advance.

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

As long as you use the minimum amount of vexol that controls your symptoms, have your intra-ocular pressure checked everry several months the risk of steroid glaucoma and cataracts are minimal. If Alrex is available in your country you might try that, it's an even milder steroid.  I do not think your disease flares up because of 'steroid rebound'.  Using Restasis for Thygeson's disease is an off lable use but has helped some people.  While not saying I approve of the practice, prescription drugs are available over the internet and sent all over the world. If you are willing to  pay the cost of Restasis your ophthalmologist could write a prescription and you could have it filled over the net. I know this happens all the time because of patients in my practice.

JCH MD Eye Physician & Surgeon    ophthalmologist = Eye MD