Staphylococcal keratitis question

[Holly519]

My ophthalmologist has diagnosed me with staphylococcal keratitis. It started in my left eye about six weeks ago and the doctor has been bringing me back in to the office every week for about the past four weeks. It started with a small amount of redness around my cornea in my left eye. I was prescribed Lotemax 0.5% four drops per day. This seemed to help for a day and then my eye started to become more red again. I called the office and generic Tobradex was next. After I had used these drops for a couple of days multiple bumps with little white spots in the centers began to form inside my upper eyelid. These bumps are not firm but they hurt like a rock is inside my eyelid and they are right over my cornea when I close my eyes. I was then switched to Blephamide 10%/0.2% which also seemed to help at first. Now I am using Omnipred 1% which I have been using four times per day for the past 14 days and this infection still has not cleared. Today I discovered it in the right eye also. In the right eye I first noticed the bumps and then I noticed the redness at the edge of the cornea. I have had these infections before. Years ago I had them once or twice every year but have not had this problem in about three years. The only difference now is the bumps in my eyelid which I have never had before.

I would appreciate any suggestions or insight into what might be happening with my eyes. What are these bumps and is there anything I can do help them go away? Why is this infection not responding to any of the drops I've tried? What should I do now?

[Holly519]

Thank you both for your comments. As I said before, I have had this problem in the past although without the painful eyelid bumps. But it always seemed to clear up within a week or so before. I have been using the same ophthalmologist for years and have become comfortable with him and his staff but it seems the best next step may be to seek a second opinion from a corneal specialist.
Thanks again, Holly.

[Sandy Feldman, MD, MS]

Dear Holly519,

I would recommend that you seek the care of a corneal specialist to determine the lack of response and diagnosis.  I cannot tell from your description whether you have solely staphylococcal keratitis or have a marginal keratitis, which may be an inflammatory response to the toxins of staph.  The differentiation and treatment may differ.  

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[Michael J Kutryb, MD]

Generally these situations require proper antibiotic drops and steroid drops to some degree but that has to be determined by the individual case by case basis.  Lid margin cultures may be helpful in some cases and some attention needs to be paid to the health of the lid margins to keep the future problems down.  Sometimes oral agents can also be helpful with the lid margin situation as well as gels like sterilid to clean the lids.  It doesn't sound like you are doing terribly well so far, so you could consider getting a second opinion with a corneal specialist ophthalmologist if you feel the need.  SOme patients have resisitant staph and that is getting quite common and is very difficult to treat.

MJK MD