Managing Viral Conjunctivitis Complications: Corneal Inflammation Concerns - Ophthalmology

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What are the treatment issues when viral conjunctivitis infects the cornea?


Hello Doctor,
On December 20th, I underwent surgery for a chalazion on my left eyelid at the ophthalmology department.
The doctor prescribed Warm Compress, to be used twice daily, as well as Jingcai eye drops and Gentamicin eye drops three times a day.
Three days later, my left eye started to become increasingly red, and despite continuing to use the eye drops, it remained red and itchy.
On December 27th, during a follow-up visit, the doctor informed me that I had contracted an adenoviral infection and needed to change my medication.
I was prescribed Dexamethasone and Patanol eye drops three times a day, and I was advised to continue using the Warm Compress.
However, after another seven days of treatment at home, my eye still did not improve; it remained red and itchy, with increasing discharge.
On January 3rd, due to the lack of improvement, I consulted a different ophthalmologist, bringing the previous doctor's prescriptions for reference.
The new doctor prescribed Betamethasone (two drops at a time), Olopatadine (three drops at a time every three hours), and allowed me to continue using the Warm Compress.
However, after three days of this treatment, my eye swelled to twice its size, and the conjunctiva became more inflamed, looking as if it was about to weep.
I began to feel dizzy and nauseous, so on the fourth night, I stopped using Betamethasone and applied ice to my eye, which slowly reduced the redness and swelling.
However, my right eye started to itch, and the amount of blood-tinged discharge increased.
I also found it difficult to see clearly with my left eye.
On January 8th, during a follow-up visit, I asked the doctor if my right eye was also infected and whether the vision impairment in my left eye indicated that the cornea was also starting to become inflamed.
After examination with instruments, the doctor confirmed that there was an infection and inflammation, stating that this was not easy to treat.
She prescribed a gentler medication: Bepotastine for the left eyelid to reduce swelling, along with Ketorolac and Patanol, one drop each every three hours.
She advised against using any of the previous medications.
I have several questions for you, Doctor:
1.
According to the information I found, Bepotastine is an antihistamine for treating eye allergies.
Educational materials indicate that corneal inflammation requires prompt medical attention, but the medication I received only addresses allergies.
Will this be effective for conjunctivitis combined with corneal inflammation? I am very concerned about the potential for permanent vision damage due to keratitis, and I fear that if this treatment does not work, the longer I wait, the worse my eye condition will become.
Currently, I can only see documents clearly when they are within 10 centimeters of my left eye while wearing glasses.
2.
My right eye is also infected, but the doctor only prescribed an antihistamine.
Will this be sufficient to suppress the viral infection? Shouldn't I be using a medication like Olopatadine, which prevents bacterial infections, as I did for my left eye?
3.
I read that Bepotastine ointment could worsen viral conjunctivitis and keratitis.
Would it be better not to apply it at all?
4.
I am very worried and having trouble sleeping.
Should I go to a major hospital's ophthalmology department for further examination? My vision has deteriorated, and I can only ask my friends to help me with my questions.
I am genuinely concerned about the possibility of blindness.
Thank you for your assistance!

Jili, 40~49 year old female. Ask Date: 2024/01/09

Dr. Gao Pilin reply Ophthalmology


Hello: 1.
Koshuyan contains antihistamine components and is typically used to relieve symptoms of eye allergies, such as redness, swelling, itching, and increased discharge.
In cases of conjunctivitis complicated by keratitis, this medication may help alleviate eye allergy symptoms, but its effectiveness in directly treating keratitis may be limited.
If keratitis persists, please return for a follow-up examination.
2.
For the viral infection in the right eye, antihistamines can provide some relief for eye allergy symptoms, but their direct inhibitory effect on viral infections is limited.
The specific treatment approach should be based on the physician's recommendations and examination results.
If you are concerned about the persistence of the right eye infection, it is advisable to consult with an ophthalmologist to ensure appropriate treatment.
3.
Bidashuang eye ointment is generally used to reduce eye inflammation and redness.
However, if symptoms worsen after use, especially with increased redness and pain, please consult an ophthalmologist to determine whether to continue using it or to switch medications.
4.
If your symptoms continue to worsen or if you experience new symptoms, such as persistent blurred vision, severe pain, or significant redness and swelling, consider visiting the ophthalmology department of a major hospital for an examination.
Wishing you a speedy recovery.

Reply Date: 2024/01/09

More Info


Managing viral conjunctivitis, especially when complications like corneal inflammation arise, can be quite challenging. Your situation, involving persistent symptoms and concerns about potential vision loss, is understandably distressing. Let’s break down your questions and concerns regarding your eye condition.

1. Use of Antihistamines for Inflammation: Antihistamines like the one you mentioned (可舒炎) are primarily used to treat allergic reactions and may not directly address viral infections or inflammation caused by viruses. In cases of viral conjunctivitis, especially when there is a risk of corneal involvement, it is crucial to use antiviral medications if indicated. While antihistamines can help alleviate itching and redness associated with allergies, they may not be effective for treating viral conjunctivitis or preventing corneal inflammation. If your symptoms persist or worsen, it is essential to follow up with your eye care provider for a more targeted treatment plan.

2. Treatment for Right Eye Infection: If your right eye is also showing signs of infection, it is important to ensure that you are receiving appropriate treatment. Antihistamines alone may not be sufficient to control a viral infection. Typically, antiviral medications or specific treatments for viral conjunctivitis are recommended. If your doctor has not prescribed any antiviral treatment for your right eye, it would be prudent to discuss this with them, especially given your history of complications with the left eye.

3. Concerns About Topical Treatments: The use of certain ointments or drops, such as 比達爽, should be carefully considered in the context of viral conjunctivitis. Some treatments can indeed exacerbate viral infections or lead to complications. If you have concerns about the potential for worsening your condition with a specific medication, it is best to communicate these worries with your ophthalmologist. They can provide guidance on whether to continue or discontinue certain treatments based on your current symptoms and examination findings.

4. When to Seek Further Medical Attention: Given your ongoing symptoms, including significant visual impairment and discomfort, it is advisable to seek a second opinion or further evaluation at a larger medical center or specialized eye clinic. If you experience worsening symptoms, such as increased redness, pain, or changes in vision, you should seek immediate medical attention. Early intervention is crucial in preventing potential complications, including corneal scarring or vision loss.

In summary, managing viral conjunctivitis with complications requires careful monitoring and appropriate treatment. It is essential to communicate openly with your healthcare providers about your symptoms and concerns. If your current treatment plan does not seem effective, do not hesitate to seek further evaluation. Protecting your vision is paramount, and timely intervention can make a significant difference in your recovery.

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