Corneal Melt

[JJJONES]

My sister's eye specialist  has been unable to determine "why" she developed corneal melt.  The typical causes have been ruled out, rheumatoid arthritis, etc.  My online readings indicate corneal melt is often a symptom of the herpes virus - this may be relevant since my sister had several genital warts removed by a cancer specialist on a few occasions.  "Cancer" was not evident as she wasn't treated  with radiation or chemo; she merely has the warts removed and examined by the cancer specialist as needed. To my knowledge, she has not shared ALL of her symptoms with either doctor; therefore, they are unlikely to conclude Herpes as a source of BOTH problems.

My question is this:  Would routine diagnostics for either condition reveal Herpes if it were  present?  She's been prescribed many steroidal treatements for her eye and the warts, and anti-infection medications for her eye, and is on a heavy dose of morphine for two years.  Her family doesn't know WHY morphine is warranted and IF the powerful meds could worsen an underlying herpes condition, if it is present.  

Any thoughts, advice, and/or educational resources are most welcome.  Please share . . .

Thank you.

[Ray T Oyakawa, MD]

Why is she on morphine?  Could she be sleeping with her eyes open?

They can do blood tests for herpes, but it is very common.  If she has an active infection and culture may be positive.

Dr. O.

[JJJONES]

Thank you for your prompt reply . . .

Below is my sister's diagnosis and the medicine she takes daily. She has taken morphine
at these levels for two years. Our family does not understand WHY the huge doses are
prescribed. (Meds not prescribed by Eye doc or VIN/VAIN doc but by referring physician):

Diagnosis:

VAGINAL INTRAPATHELIA NEOPLASIA 3 (Vin 3)    
VULVAR INTRAPATHELIA NEOPLASIA   3 (Vain 3)  

Morphine IR 15 mg.                                1 pill 3-4 a day
Morphine ER 15 mg.                              1 pill 3x a day
Morphine ER 30 mg                               1 pill 2 x a day
Nortriptylene   25 mg.                             1 pill at bedtime
Estradiol     1 mg                                   1 pill day
Naprosyn   500 mg.                               1 pill 2 x day
Furosemide (Lasix)  20 mg.                    1 pill 2 x a day
Hydroxyzine * (only as needed) 10 mg    1 pill every 8 hours
Zantac   150 mg.                                   1 pill daily
Lidoderm * (only as needed) 5 %       1 patch- 12 hours on & 12 hours off (As needed)

Not taking radiation or chemotherapy, so no obvious cancer diagnosis rendered.

CORNEAL MELT

Vigamox   0.5 %              1 drop in right eye 4 x a day
Xibrom     0.09 %             1 drop in right eye 2 x a day
Prednisone  60 mg.          1 pill 2 x day

The answer to the question you posed:  No, she does not sleep with her eyes open. Why so
much morphine then?  This may be beyond your area of expertise but perhaps you could share
the normal treatment regimen and medication prescribed for corneal melt?

We are concerned my sister has not disclosed each finding to each physician which may
explain why genital warts AND corneal melt haven't been associated, and why Herpes hasn't
been identified as a potential cause.

Any advice or insight you can offer, Dr. O?  Should we find an obscure way to share ALL info
with each doc so they can follow up with each other and with her individually?  We don't want to
anger my sister, intrude on her care, or risk offending the physicians, but we are all very,
very concerned about her.

Thank you in advance for any guidance and insight you may offer.  It is most welcome.