Persistent inflammatory conjunctivitis

[KymeraAHP]

I have had inflammatory conjunctivitis for 5 years. It started when I was 18 when I was hospitalised for a fast acting and vicious facial herpes and bacterial infection outbreak that riddled me head to toe. I am now on regular aciclovir and loratadine. It took years to recover from all the health issues that resulted from the outbreak and to manage flareups but one thing I haven't gotten a hold of is the conjunctivitis. I have had no history of eye issues prior, everything was healthy and fine. I am under the care of opthalmologists with regular check ups due to Keratoconus which is monitored and treated and has rendered me legally blind. Totally blind until I had a corneal transplant coming up 2 years ago in the right eye. I have tried to speak to my opthalmologists in regards to the conjunctivitis but they wave it off and prescribe a short course of Fml, Pred Forte, Maxidex or Prednisone depending on the severity of the flareup. They are very skeptical about prolonged use of steroids and I understand why. I have now developed dry eyes in the last year and it seems the issue with the conjunctivitus is worsening. I have flareups once a month if not twice and it's getting to a point it is severely impacting my mental health. I don't want to go to sleep eveynight and fear I have to rip my eyes open the following morning. There was one time the conjunctiviris calmed down to flaring up once every other month and that was when I had the transplant to right eye and my surgeon prescribed Pred Forte for the right and FML for the left until the stitches were removed. After the removal the regular steroids were stopped and my surgeon handed my care back to my opthalmologists. I am also regularly on Patanol and lubricating drops. How can I address this issue to my opthalmologists to encourage them to look into alternative methods of treatment if there are any rather than prescibing a short course during an active flareup? I am already aware of basic eye care but are there any additional ideas that I could try at home to improve my situation in regards to how to care for my eyes during and in between flareups. It is also imperative to get a hang of this now because it has been suggested by my surgeon to begin wearing contacts (too blind for glasses) in hopes it will further improve my vision in my right eye, they are now questioning whether it is viable due to the conjunctivitis and he will not operate on my left eye until he is happy with my right eye.

[JohnHaganMD]

Inflammatory conjunctivitis describes a mechanism but not a cause.   Chronic steroids are a bad deal for many reasons including cataract formation, glaucoma, reactiviation of your Herpes and bacterial or fungal infections.  I suspect your contact lens where will greatly make your eyes more red and irritated. I suggest you get an independent second opinion from a different cornea/external disease specialist.  Ask about specific tests like tear osmolality, schirmer test, rose bengal staining for dry eyes and about going on Restasis or Xiidra chronically for your irritated likely dry eyes.

[KymeraAHP]

Thank you very much I really appreciate it. Your response is very helpful :)

[JohnHaganMD]

Best of luck and if you ever get an answer please re-post so others may benefit.  Both my wife and I are on Restasis for chronic dry, red, irritable eyes for several years with excellent results.  If you do go on restasis get the individual vials not the multi-dose bottle as the individual vials are much less expensive.