General health

[ace555]

I had cataract surgery (right eye only) in March. Since that time I have not been able to get off the steriods. Doctors have given up, said there is notheing they can. Used omnipred 4 x day for 2 wks, then 3 x day,2 x day, 1 x day, then every other day and stop. 2 days after stopping, eye become red, light sensitive, painful, very inflammed, Must go back on the drops. This has been since March. Also have ocular hypertension in both eyes, uses Alphangan P 2 x day. Worried about the long term use of omnipred and how to get off this steriod. Vision has not returned clearly from the last time inflammed, very blurred since  6/28/10. Any help very much appreciated.

[ace555]

Please advise who best perform these test/cultures/procedures? Primary care physician, retnia specialist, opthmologist,  My opthomologist did not mention the problems you suggested.  He may not want to do any tests since he has said there is nothing else he can do.  

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Redness in the eyes can be due to allergy, dry eyes, a turned in eyelash, foreign body in the eye, corneal ulcer, conjunctivitis, and glaucoma. It can also be a sign of stress, eye strain or poor eye sight. Since it started after cataract surgery, there is some lingering infection. Steroid should be stopped for 72 hours and then a swab taken and cultured. Foreign body in the eye is also a possibility. It is also possible that your eye is allergic to the lens placed during surgery. Repeated infection could have blocked the draining channels of the anterior compartment of the eye and this could be causing the raised pressure.
I would suggest you take the opinion of another eye specialist regarding this.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

[mastermind002]

You are suffering from one of the post surgical complications.I think you might be suffering from TASS( Toxis Anterior Segment syndrome) or maybe you are suffering from Infectious endopthalmitis. You can differentiate between the two as follows:
ONSET. Usually, TASS has an earlier onset (ie, 12 to 24 hours after surgery) than infectious endophthalmitis( appearing 4 to 7 days post operation).
CULTURES. Cultures can determine whether the inflammation is infectious or not.Usually, cultures are positive with infectious endophthalmitis, although they can be negative in some cases.
CORNEAL EDEMA. Although corneal edema exists in both conditions, the edema in TASS is more profound and characteristically is diffuse, from limbus to limbus (ie, the marginal region of the cornea of the eye by which it is continuous with the sclera).The corneal edema present with infectious endophthalmitis tends to be specific to the area of trauma (eg, near the wound or opposite the wound.
PAIN. Most patients suffering from TASS complain of only mild to moderate pain.Patients experiencing infectious endophthalmitis generally report pain that is more severe, which usually is regarded as diagnostic. Approximately 25% of patients diagnosed with infectious endophthalmitis, however, do not report experiencing pain.
INTRAOCULAR PRESSURE (IOP). With TASS, marked inflammation initially may be associated with lower IOP.As the days progress, however, the pressure is likely to increase suddenly as aqueous humor production increases postoperatively. Toxic anterior segment syndrome affects the trabecular meshwork (ie, a sponge-like, porous network of connective tissue through which continuously produced aqueous humor drains from the eye). Pressures as high as 40 mm Hg to 70 mm Hg may be measured. Permanent damage to the trabecular network can result, thus creating a risk for glaucoma.The IOP of a patient with infectious endophthalmitis usually is not elevated.
NFLAMMATION. Toxic anterior segment syndrome is characterized by immediate and marked anterior segment inflammation, with increased presence of white blood cells as a result of the marked breakdown of the blood-aqueous barrier; flare (ie, an area of redness spreading outward from an infected area or lesion that extends beyond the locus of reaction to the irritating stimulus); and especially fibrin formation. Sometimes there is hypopyon(its pus on the eye),the size of which may be out of proportion with the quantity of cells and amount of flare observed.  profound, acute breakdown of the blood-aqueous barrier produces hypopyon in TASS. With infectious endophthalmitis, there is an increased cellular reaction in the anterior chamber, which occurs over a longer period of time than the inflammation in TASS.
PUPIL. Iris atrophy may be significant in TASS.Toxic anterior segment syndrome can impair the iris sphincter tractional causing the pupil not to react well to light (ie, not to dilate...

                                                Treatment
It is very important to diagnose properly as TASS and infectious endopthalmitis are treated differently.
Go to the following page for the treatment of TASS: http://emedicine.medscape.com/article/1190343-treatment

The post operative infectious endopthalmitis is treated ad follows: http://emedicine.medscape.com/article/1201260-treatment

(Important note:Please consult an opthalmologist before taking any medicine)Thank you and let me know if I could be of any further help. God bless you!