Persistent Eye Irritation: Treatment for Allergies or Infection

Q: Persistent Eye Irritation: Treatment for Allergies or Infection

Hello, Miss： Based on your description, your condition is likely a "stye," also known as a "hordeolum." The primary cause is the blockage of the sebaceous glands, which prevents the oil from being released, allowing bacteria to proliferate, leading to redness, swelling, and pus a

Itchy eyes, discharge, and pus-filled bumps on the eyelids that are not improving?

In April, I experienced itchy eyes with discharge and pus-filled bumps on my eyelids.
The ophthalmologist at the clinic diagnosed it as inflammation and prescribed medication.
At the beginning of May, my eyes still hadn't improved, so I returned to the same clinic, and the doctor again diagnosed it as inflammation and prescribed more medication.
In mid-May, I switched to the ophthalmology department at a hospital.
By this time, my eyes were itchy, dry, had discharge, and new pus-filled bumps had appeared.
The doctor diagnosed it as a bacterial infection and prescribed antibiotic eye drops (Tobramycin), erythromycin ointment, and oral anti-inflammatory medication.
After a week and a half, aside from the discharge, my eyes remained dry and itchy, and I noticed slight swelling under my eyes.
I returned to the same doctor at the hospital, who instructed me to continue using the previous prescriptions and added a new eye drop (Fucithalmic) for inflammation and an antihistamine eye drop (Azelastine).
However, by mid-June, my eyes were still dry, itchy, swollen, and had discharge.
I went back to the hospital to see a different doctor, who stated that I had "excessive discharge from the eyelids leading to conjunctival inflammation." He prescribed the same eye drops (Fucithalmic and Azelastine), but when I went to pick up the medication, I realized it was the same as before, just without the erythromycin ointment and oral anti-inflammatory medication.
(I informed the new doctor that I had been coming for a month without improvement.) The previous doctor had advised against using Fucithalmic unless absolutely necessary, recommending a maximum of two applications per day, but the new doctor suggested using it four times a day.
I am concerned about whether these medications are actually helping my eyes and whether this is an allergy or something else.
I fear that continuing this treatment will not lead to improvement.
When I mentioned my concerns to the doctor, he just prescribed similar medications again.
Thank you.

Xiao Shan Cun, 30~39 year old female. Ask Date: 2006/06/14

Dr. Liu Jingxian reply Ophthalmology

Hello, Miss: Based on your description, your condition is likely a "stye," also known as a "hordeolum." The primary cause is the blockage of the sebaceous glands, which prevents the oil from being released, allowing bacteria to proliferate, leading to redness, swelling, and pus accumulation in the gland, resulting in a stye.
In some individuals, if the stye is more superficial and the pus accumulation is severe, it may swell into a pustule.
In others, if it is deeper and the pus accumulation is milder, it may not form a pustule but instead present as localized redness and swelling.
Possible causes of a stye include: 1.
Excessive "fatigue" or consumption of too many fried foods, legumes, nuts, high-fat foods, and spicy foods, which can cause the secreted oil to become abnormal.
2.
Seborrheic "constitution": skin prone to acne, oily hair, eyelids that are also oily, congested, flaking, and eyelashes that may fall out or grow abnormally, often with oil accumulating at the eyelid margins, blocking the sebaceous glands.
Treatment for a stye may include applying "antibacterial" solutions or ointments, along with some "steroid eye drops" to reduce local swelling, and possibly oral antibiotics.
If there is a significant amount of pus that cannot be drained, incision and drainage of the abscess may be considered.
To prevent styes, it is advisable to reduce the intake of fried foods, nuts, legumes, high-fat, and spicy foods, while increasing the consumption of vegetables and fruits, opting for steaming or boiling in cooking, drinking plenty of water, exercising regularly, ensuring adequate sleep, and maintaining cleanliness of hair and skin.
Consider using diluted baby shampoo to clean the eyelid margins and eyelashes, and gently massaging around the eye area with a clean, warm towel for five to ten minutes in the morning and evening.
If you have any related concerns, feel free to visit the ophthalmology department at the City United Hospital.
Wishing you good health.
Dr.
Liu Jing-Hsi, Ophthalmology, Taipei City United Hospital, Zhongxing Branch, Taiwan e-Learning Academy, June 15, 2006.

Reply Date: 2006/06/14

More Info

Persistent eye irritation can be a frustrating and complex issue, especially when it involves symptoms like itching, dryness, discharge, and swelling. Based on your description, it seems that you have been experiencing a prolonged eye condition that has not responded well to various treatments. Here’s a comprehensive overview of potential causes, treatment options, and considerations for your situation.

Understanding the Condition
1. Allergic Reactions vs. Infection: Your symptoms suggest that you may be dealing with either an allergic reaction or a bacterial infection. Allergies can cause itching, redness, and watery discharge, while bacterial infections typically present with more pronounced discharge, swelling, and discomfort. The presence of pus-filled bumps (pustules) on the eyelids could indicate a more severe infection or a condition like blepharitis.

2. Chronic Inflammation: If your symptoms have persisted despite treatment, it may indicate chronic inflammation. Conditions such as chronic allergic conjunctivitis or blepharitis can lead to ongoing irritation and require a more tailored approach to management.

Treatment Options
1. Topical Medications: The medications you mentioned, such as "富眼能眼藥水" (likely an anti-inflammatory eye drop) and "愛敏定點眼液" (an antihistamine eye drop), are commonly used to manage symptoms of inflammation and allergies. However, the effectiveness can vary based on the underlying cause. If the previous doctor advised against frequent use of certain drops, it’s essential to follow that guidance, as overuse can lead to rebound symptoms or further irritation.

2. Antibiotics: If a bacterial infection is suspected, antibiotics (like the erythromycin ointment you mentioned) are typically prescribed. If you are not seeing improvement with the current regimen, it may be worth discussing with your doctor the possibility of switching to a different antibiotic or considering a culture to identify the specific bacteria involved.

3. Oral Medications: Oral anti-inflammatory medications can also help reduce systemic inflammation and may be beneficial if topical treatments are insufficient.

4. Artificial Tears: Given your symptoms of dryness, using preservative-free artificial tears can help lubricate the eyes and alleviate discomfort. These can be used frequently throughout the day.

5. Hygiene Practices: Maintaining proper eyelid hygiene is crucial, especially if you have blepharitis. Regularly cleaning the eyelids with warm compresses and eyelid scrubs can help reduce inflammation and prevent the buildup of debris.

Monitoring and Follow-Up
1. Regular Check-Ups: Since your symptoms have not improved, it’s essential to have regular follow-ups with your eye care provider. If necessary, consider seeking a second opinion from a specialist, such as a cornea specialist or an ophthalmologist with expertise in ocular surface diseases.

2. Documenting Symptoms: Keeping a diary of your symptoms, including when they worsen or improve, can provide valuable information to your healthcare provider and help tailor your treatment plan.

3. Avoiding Triggers: If allergies are suspected, try to identify and avoid potential allergens, such as dust, pollen, or pet dander. Using air purifiers and keeping windows closed during high pollen seasons can also help.

Conclusion
In summary, persistent eye irritation can stem from various causes, including allergies, infections, or chronic inflammation. It is crucial to work closely with your healthcare provider to determine the underlying cause and adjust your treatment plan accordingly. If you feel that your current treatment is not effective, don’t hesitate to advocate for further evaluation or alternative therapies. Your comfort and vision are paramount, and finding the right approach may take time and patience.

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