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Need Help with Complicated Reoccuring Eye Infection

I am an American student studying in Italy right now and before I left I developed a reoccurring eye problem. I’ve been going to a doctor here but it isn’t really helping. My history is pretty long but if anyone has the time/patience to read it I would greatly appreciate any input!

I have been wearing 2 week contact lenses with no problems for over 7 years. I have always had seasonal allergies to pollen but contacts have actually helped alleviate symptoms for me. I take 10mg of zyrtec a day during allergy season and I am mildly allergic to latex.

This past April I noticed that my upper eyelids were a little puffy so I went to an eye doctor who told me it was due to allergies and prescribed me Lastacaft. I started using it and my eyes got better.

Early this summer a) I stopped taking Lastacaft because my eyes felt fine and b) I switched from Acuvue Advance contacts to Acuve Oasys because I was told the Advance were being discontinued. Not long after the switch my eyelids became swollen again but this time it was worse, underneath my eyes became red and the whites of my eyes were slightly bloodshot. A doctor diagnosed me with viral conjunctivitis but didn’t give me any medication and told me it would go away if I wore glasses for a week and threw out all my old contact stuff and makeup.

It did go away but only to return a couple of weeks later. This time the doctor said that it was bacterial conjunctivitis. She told me to throw away my contact stuff and to wear glasses during treatment and prescribed me Vigamox. This was only a week before I left for Italy and the Vigamox seemed to make my eyes even worse so I was switched to TobraDex 3x a day for a week.

My eyes got better and the day after my treatment finished I put in a new pair of contacts. The next day I could already tell that underneath my eyes was beginning to turn red again.

A doctor in Italy prescribed me TobraDex again and said this time to wait an additional 2 days after the treatment finished before putting in a new pair of contacts. I also theorized that maybe my eyes were allergic to something in the Acuvue Oasys that was similar to latex so I ordered a set of my old Acuvue Advance while I was waiting. Like before my eyes cleared up with the Tobradex and two days later I tried wearing the Acuvue Advance lenses but soon after noticed the same old symptoms persisting.

At this point I got myself to an eye specialist who after doing a bunch of standard tests they told me she couldn’t tell if I had conjunctivitis still or not and sent me to get some tests done. The tests eventually came back negative for both conjunctivitis and chlamydia.

This process of test taking and waiting took 2 weeks, during which a new bout of swelling/itching/minor clear discharge started without the use of any contact lenses. I figured that since my symptoms reappeared without the use of contacts than the problem probably wasn’t the contacts. In this period of waiting I decided to use Tobradex again to alleviate my symptoms since it was hard to continue everyday life with irritated eyes.

After my test results came back I returned to the eye specialist. Her new theory is that I just have dry eyes and need to lubricate them more. She told me to use an unmedicated eye drop (Xiloial) 4x a day for a entire month without any contacts and to use my Lastacaft 3x a day for 10 days and then to stop using it all together. I didn’t really understand this plan but have been doing it for 3 days now and noticed last night that my eyelids are beginning to swell, yet again.

I’m seriously worried about my eyes and I really don’t know what to do. The only thing that has helped my symptoms has been Tobradex but since it is a steroid and antibiotic I obviously can’t use it as a long term solution. I really hate wearing glasses and would be happy to get to a place where I can wear contacts even a little bit of the time but I’m not sure what this next month of no contacts and no medicine is going to do anything good for me. I’m worried my eyes will get worse and that maybe something more serious is wrong with me that no one has noticed.
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replied November 13th, 2012
Thanks for your question. As you have been under the continuing care of multiple doctors and had appropriate testing and care already, I will just offer some information and options. Most of the time, these types of conditions are chronic (have been developing over a long time) and annoying, and may take weeks to months to begin feeling better again. Patience, and following your doctor's recommendations are vital to the long term comfort of your eyes and ability to continue using contact lenses.

In general, there are many causes for eye lid swelling, and associated redness in the lids themselves or redness on the eyes. A lot of the time, diagnosis may be challenging because there are many variables to the symptoms and overlap of conditions is common.

a few common causes of eyelid swelling are:
1)Allergic reactions to seasonal pollen and grasses, make-up, hair spray, pet dander, shampoo, perfumes, etc.. You can also develop allergies to your own protein deposits on contact lenses.
2)Blepharitis and Dry Eye, which are inflammatory conditions inside the eyelids usually caused by some underlying condition such as Rosacea, dry skin, dandruff, or staphylococcal infections of special oil glands (sebaceous and meibomian) that normally keep the eyelash follicles and tear film healthy and functioning properly.
3)Infectious conjunctivitis, which can be either bacterial or viral in nature. It usually causes swelling, itching, burning, and redness of the eye protective membrane.
Contact lens wearers have an increased risk of developing conjunctivitis.
4)Styes and Chalazions, which are caused by blocked oil glands inside the eyelids. Additional symptoms that may appear are redness, pain, itchiness and lumpiness of the eyelid.

Less common causes are:
1)Cellulitis and Orbital Cellulitis, which are inflammations of the soft skin around the eyes and space surrounding the eyeball. They are the result of other underlying conditions such as sinus infections, trauma, diabetes, uncontrolled conjunctivitis, etc.
2)Herpes Simplex and Herpes Zoster virus
3)Trauma to the eyelids or around the eyes
4)Insect bites
5)Parasitic conditions such as Chagas disease, which commonly results in eyelid swelling and has shown recent increase in prevalence, primarily throughout Mexico and Central America, but has also in the Southern United States.

Concerning your experience with contact lenses, the brands you mention are what are called Silicon Hydrogels. While similar in the material used to make the different generations of contact lenses, there are subtle differences.

Factors that go into contact lenses and how compatible they may be for your eyes include:

Material used. All soft lenses are made from hydrogel material. Silicone hydrogels are a recent innovation that incorporates silicone into the lens, thereby increasing how well the lens transmits oxygen to the eye. Silicone hydrogel lenses have a lower water content than previous generations of hydrogels.

Water content. The higher the water content, the softer the lens will feel initially, but as moisture evaporates off the lens surface, it will replenish itself by using the patient's own natural tears, unless rewetting drops are routinely used.

Modulus. This refers to stiffness of the material used in the contact lens. The higher the modulus, the stiffer the lens material will feel (and the less flexibility the lens will have to drape over the eye and follow the eye's natural shape). The original silicone hydrogels had a higher modulus and thus felt stiffer on the eye. Newer generations of silicone hydrogels have lower modulus results, thereby a lens that contours slightly to follow the shape of the eye.

Other factors that affect how bio-compatible a particular brand of contact lens will be for a given patient include: edge design, if the lens was molded or spun-cast, and basic fitting measurements like base curvature, diameter, and lens thickness.

One option to consider asking your eye doctor about is switching to a brand of "single use disposables". Made by many companies, these lenses would be worn only one time by the user, then discarded. This prevents the normal deposits and organisms that invade longer use contact lenses from causing an inflammatory or infectious response within the eye.

Best of luck to you!

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