Punctate Keratitis

[concerned_dude]

I'm a 32 year-old male who wears glasses occasionally (for distance, but I don't wear them while working at the computer). For the last few days, I've had mild irritation in my eyes.  (The location seemed to be near the nose in the right eye, but has spread to the bottom of the right eye and now near the nose in my left.)  I saw the opthamologist two days ago and he diagnosed punctate keratitis and seemed unconcerned.  He gave me about 3 days worth of antibiotic drops (the name escapes me) which will be done tomorrow.  I haven't noticed any improvement.  If anything it seems to have gotten worse (though, admittedly, there's no blurred vision or pain, just occasional and slight burning, which may be the result of eye drops, and general irritation as if there's something in my eye that I can't get out).

When I googled the condition, the cause was incredibly unspecific (viral, bacterial, UV exposure, dry eyes, ...).  The opthamologist looked at my right eye with a slit lamp and suggested UV exposure.  Is it possible for him to tell the cause by looking at it, or was he making an educated guess?  What concerns me is the possibility of viral (specifically herpetic) infection.  (I have no rational reason to think that, but I can't get the thought out of my head.)  Could that have been diagnosed with the slit lamp?

If things haven't improved, I plan to schedule a follow-up visit later in the week.  Is there anything in particular I should ask when I'm there?

[concerned_dude]

If there's anyone out there listening, I should update the situation.  While certainly not unbearable, my eyes have started burning today.  Non-prescription drops at the office seem to alleviate the burning somewhat.  I've made an appointment for Friday, but this is certainly troubling.  Any advice would be greatly appreciated.

Thank you.

[Flavius G Pernoud III, MD]

As you have found out, there are many causes for punctate keratitis. It is a non-specific inflammation of the epithelium of the cornea. Sometimes the root cause is not obvious and treatment is trial and error. Are you taking any medications by mouth? They may be drying your eyes. You might have something toxic affecting your eyes--something you are putting on your skin. Try some preservative free ocular lubricants frequently. Give your doctor a chance to explore some different things.

[ncguy]

Thanks.  I'm not taking any medication (orally or otherwise).  I got some preservative free drops that I've used a few times a day.  They seem to help.  (I've never used eye drops of any kind before. Is there a concern with over-doing the lubricating ones?)  By something toxic on my skin, do you mean like a facial cream?  I don't think I've used it any more than usual, but I have used some over-the-counter acne cream (but in my chin, not near my eyes).

Thank you!