Corneal Healing: Fluctuating Vision After Keratitis

Corneal abrasion after keratitis for over a month?

Hello Doctor, I would like to inquire about my condition.
I developed conjunctivitis in my right eye on February 7, which progressed to keratitis by February 15, leading to a corneal abrasion that has lasted for over a month and a half.
My vision deteriorated to 0.1 due to the slow recovery.
I have undergone serum therapy at the hospital, along with the use of artificial tears.
I alternate between preservative-free single-dose artificial tears and bottled ones, and I use Vidisic Gel at night.
Currently, the white cloudy blur has improved, but my focusing ability remains poor.
Sometimes my vision is clear one day and blurry the next morning, or it can be blurry in the morning and clear in the afternoon, or vice versa.
This has been fluctuating for over a week.
I thought that once I achieved clear focus, it would remain clear, so why does it change so much after sleeping? It makes me anxious every morning about what my vision will be like that day.
Additionally, my left eye, which was not infected before, has recently developed an abrasion as well, with vision dropping to 0.8, and the doctor could not determine the cause.
Furthermore, I had laser surgery for my myopia at the age of 24, and I have not worn contact lenses or had myopia in recent years.

Petti, 40~49 year old female. Ask Date: 2022/03/28

Dr. Liang Ce reply Ophthalmology

I recommend that you 1.
discuss the above situation further with your attending physician to determine if any additional examinations are necessary.
2.
visit the ophthalmology outpatient department at a medical center or large hospital.
Thank you, and wish you good health!

Reply Date: 2022/03/28

More Info

Understanding fluctuating vision after keratitis can be quite complex, especially when considering the various factors that can affect corneal healing and overall eye health. Based on your description, it seems you have been experiencing a prolonged recovery period following your keratitis, which has led to significant fluctuations in your vision.
Keratitis, which is an inflammation of the cornea, can result from various causes, including infections (viral, bacterial, or fungal), trauma, or underlying conditions such as dry eye syndrome. The healing process of the cornea can be influenced by several factors, including the severity of the initial injury, the presence of any secondary infections, and the overall health of your eye.
The fluctuations in your vision that you are experiencing—where your vision can be clear one moment and then become blurry the next—can be attributed to several potential causes:
1. Corneal Edema: After keratitis, the cornea may become swollen (edematous), which can lead to temporary blurriness. This swelling can fluctuate based on various factors, including your eye's hydration levels and the effectiveness of your treatment regimen.

2. Tear Film Instability: Given your history of dry eye syndrome, the stability of your tear film is crucial for clear vision. If your tear film is unstable, it can lead to fluctuating vision, especially throughout the day or after sleeping. Using artificial tears and gels, as you mentioned, is a good approach, but it may take time to find the right balance that works for you.

3. Corneal Surface Irregularities: Following keratitis, the surface of the cornea may not heal perfectly smooth, leading to irregularities that can affect how light is refracted through the cornea. This can cause variations in vision clarity.

4. Changes in Eye Pressure: Fluctuations in intraocular pressure can also impact vision. If your eye pressure changes, it can lead to temporary blurriness.

5. Underlying Conditions: If you have any underlying conditions, such as autoimmune diseases or other systemic issues, these can also affect your eye health and contribute to fluctuating vision.

Regarding your left eye developing a corneal abrasion without prior infection, it is possible that the overall health of your eyes is interconnected. Sometimes, when one eye is compromised, the other may become more susceptible to injury or irritation, especially if you are unconsciously rubbing or straining your eyes more due to discomfort in the affected eye.

As for your concerns about the variability in your vision upon waking, this can be quite common. Overnight, your eyes may not produce as many tears, leading to dryness and temporary blurriness upon waking. As you blink and your tear film stabilizes throughout the day, your vision may improve.

To address your situation, here are some recommendations:
- Follow-Up with Your Eye Doctor: Since you are experiencing significant fluctuations in vision, it is essential to maintain regular follow-ups with your eye care provider. They may recommend additional tests to assess the health of your cornea and overall eye condition.

- Optimize Your Treatment Regimen: Continue using the prescribed treatments, including artificial tears and any other medications. Discuss with your doctor the possibility of adjusting your treatment plan if you are not seeing the desired improvement.

- Monitor Symptoms: Keep a journal of your symptoms, noting when your vision is clear and when it is blurry. This information can help your doctor identify patterns and potential triggers.

- Avoid Eye Strain: Ensure you are taking regular breaks from screens and other visually demanding tasks to reduce eye strain.

- Consider Environmental Factors: Dry environments can exacerbate dry eye symptoms. Using a humidifier and ensuring adequate hydration can help.

In conclusion, while fluctuating vision after keratitis can be frustrating, it is often a part of the healing process. With proper management and regular follow-up care, many patients see improvement over time. Always consult with your eye care professional for personalized advice and treatment options tailored to your specific situation.

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