Pink eye for 10 months (Keratoconjunctivitis)

[pinkeyepete]

I have had pinkeye or post symptoms for pinkeye for 10 months! I work in HCMC, Vietnam and I got viral conjunctivitis (pink eye) followed by keratitis (keratoconjunctivitis) in October 2008. It has come and gone, with only a month of relief and no symptons after 4 months during Jan-Feb 09, before the keratoconjunctivitis came back for the last 5 months. I have been to many opthamologists, both in Vietnam (who have treated me with cold compresses, antibiotic ointments and water refresher drops) and also in Australia (where I was treated with topical steriods and water refresher drops). Following the disuse of steroids the eye flared worse and my opthamologist in Vietnam said I should not have been treated with steroid for this very reason (supresses viral symptoms only to come back), but rather have to let nature take its course given it is viral. I now seem to have very small swelling or irritation under the eyelid of the affected eye (not noticeably concerning but just feels irritating and when i fold the eye back I can see it is irriated and slightly swollen). I am not sure if my eye is just irritated but I still seem to have signs of conjuctivitis, watery irritated eyes especially in morning etc. If it is irritated, I'm wondering how to relieve this given theres a little bit of swelling. Keratitis is now clear but if it is pinkeye, Im contuing with cold compresses and refresher drops, with the hope this will go away. My doc in Vietnam is foreign educated and assures me that although rare, pink eye and bad cases of keratitis can last for up to 2 years (mine was severe). ANY ANY ADVICE especially from any docs/opthamologists would be appreciated. I have no other medical conditions and have had blood tests and swabs taken in australia of my eye - all clear. very frustrated as I want to be well again. can viral conjunctivitis last this long? or am i experiencing ongoing symptons, irritation and eyelid swelling due to dusty environment? your advice appreciated.

[pinkeyepete]

Thanks Dr Hagan.

I'll certainly be seeking a doctor possibly in Singapore or Bangkok given your advice.

If anyone in this forum can refer me the name of a good opthamologist in South East Asia (most probably Singapore or Bangkok) would be appreciated. Vietnam's still a little behind in terms of options...

[Pbtb]

Hi, I came across your situation about EKC. I believe I'm going through similar one when I stopped steroids the virus seems to come back. I was wondering how long did your condition last. Did you take any special care other than cold compress and tear drops to get healed faster?

[JohnHaganMD]

Steroids for prolonged us have lots of potential side effects including cataract formation and glaucoma. Newer studies show restasis (cyclosporin) may work https://bmcophthalmol.biomedcentral.com/articles/10.1186/1471-2415-12-42

[John C Hagan III, MD, FACS, FAAO]

1. Your body kills the virus. That's what makes it go away. The steroids can shorten the course of the disease, may reduce the formation of opacities and once they are there suppress them by speeding the fading process. Yes they can come back when steroids are stopped but often they don't especially if a long taper is used. If I ever get EKC you can bet I will ask to be treated with steroids.

2. 8% of people that are on steroids for over a month can develop increased IOP that usually goes away when the drops are stopped ("steroid responders"). However the risk minimal when special steroids are used: FML or Vexol.  As far as side effects go each year in the USA about 6000 people bleed to death from aspirin. That doesn't stop me from taking 4/day.

JCH MD

[pinkeyepete]

Thanks Dr Hagan.

One last thing.

a) On the steroids; do they actually help the EKC go away or lessen the time one is sick? I understand they relieve the symptoms, i.e they can make the corneal opacites go away and lessen other symptoms, but does this only supress the EKC for them to come back after? (This is argument my doc is advocating).  

b) And the other argument is that he said prolonged steroid use can cause glaucoma or worse and as such I'm better to let EKC run its course. Any views on that?

Thanks again

[John C Hagan III, MD, FACS, FAAO]

1. Not uncommon
2 EKC is not that unusual that it requires any special type of ophthalmologist. I don't agree with your VN Eye MD not using steroids
3. No

JCH MD

[pinkeyepete]

Thanks Dr. Hagan. Sorry I forgot to mention all doctors had already diagnosed it as  EKC and I do have corneal opacities that are able to be seen in a slit lamp but are slowly going away. I discovered this after some vision loss and now its slowly coming back.  

I do have a few more questions if you or others are able to assist;
a) Is it normal for EKC to last so long?
b) Are there any particular specialist opthamologists with experience in EKC I should be seeking? (I can travel within South East Asia - singapore, bangkok).
c) Is there anything I can do to overcome this? (Currently not taking steroids, just cold compresses and refresher drops)

[John C Hagan III, MD, FACS, FAAO]

Your story suggests corneal adenovirus disease such as EKC. It often follows a protracted course, does not respond to antibiotics because its viral and can cause opacification (cloudy spots) on the cornea. It IS typical to treat these with steroid drops to hasten the resolution , make the person more comfortable and if the vision is down to help the cloudy areas dissolve.

It requires careful monitoring for steroid side effects and the person may be on the steroids for several months. the last person i treated was a pediatrician.

So I do not think you were mistreated by the Australian MDs.

Given Viet Nam only has state run medicine you don't see like you have much choice.

Go to Google images type in EKC corneal opacities and see what they look like

JCH MD