Marie wrote:
I just came down with a case of viral pinkeye. I know I shouldn’t wear my contacts, but I can’t see without them. I don’t have glasses, nor can I afford them. I live alone and need to continue functioning in society - but without my contacts, I can’t. I need to wear my contacts.
How do I take care of my eyes while still managing my life?

ANSWER

Marie,

The only way to get rid of an infection is to leave your lenses off until the eye is completely healed.  The Virus / organism causing the infection can stay in the material of the contact lens and continually re-infect your eye.   You will need to start with a fresh pair of lenses once the infection is done.   I’m sorry, no one should even consider wearing contacts unless they also have a pair of glasses as a backup.

Dr. Joan Hansen, Optometrist for CAO

Dave wrote:
22 year old Male

I am starting to get concerned about my ongoing pink eye. I visited a doctor when it started in early June, and she concluded that it’s viral pink eye so nothing can be prescribed to help me. Well, that was 5 weeks ago now and my symptoms are only getting worse. I can’t go to work without dumping Visine in my eyes as they’re so red when I wake up I’d scare people. I realize Visine will give me red-eye rebound effect, but I’ve only been reliant on them for about 3 days now, as it’s only gotten that bad in the last week. I had pink eye last year and the symptoms were very similar and lasted a couple months. I’ve tried using Systane, but that doesn’t alleviate any symptoms.

I have no discharge whatsoever, just scratchy/itchy eyes, occasional light pain, and extreme redness. I had pink eye last year which the doctor called allergenic and prescribed me Patanol. It didn’t help then, and it doesn’t seem to help now.

Should I see my doctor or an optometrist? I’m confused about whether an optometrist can diagnose or prescribe.

ANSWER

Dear Dave

Pink eye constitutes a world in itself. I am teaching primary care at the University and we see a lot of cases ending up in our chair with a history like yours.

Obviously the right treatment comes only after a good diagnosis. A good diagnosis is based on a good examination on an appropriate knowledge of the condition. I fully respect general practitionners but they are educated about eye diseases for only 2 weeks during their 5 year curriculum. Optometrists are skilled and trained during 4-5 years to diagnose and treat eye diseases. Depending where do you live, optometrists can prescribe or not. In Ontario for example, the law is passed to authorize them to prescribe but this is not implemented yet. In Alberta, Quebec or New Brunswick, Nova Scotia or Saskatchewan and Newfoundland, optometrists can prescribe ocular drugs. At least, in every province they can recommend to your general practitionner the most effective treatment.

To be back to your case, this eye can suffer from a viral infection. More than this I would make the hypothesis of an adenoviral infection. A type of virus that can last for several weeks.

The first treatment is to wash the ocular surface quite often to eliminate viral toxins that cause redness. Systane is a good product but to be used up to 4 times a day only, not enough to be effective. Visine, as you witnessed, creates rebound effect and should NEVER be used on an active inflammed eye. More than the rebound effect, its use contributes to mask clinical signs. This can delay the appropriate diagnosis. So stop it! Even if you have 2-3 days of rebound effect, it will fade out.

Back to basics would be my approach:

1) Cold compressed: 1-2 minutes each time - 4 times /day for 3 days and twice a day after.

2) Lubricate intensively with non preserved artificial tears (best ones: Bion Tears from Alcon or Refresh Unidosis from Allergan) - available over the counter.  Regimen: 1 drop hourly during waking hours for 3 days.

If the redness is still intense and the symptoms are not getting better, consider after this 3 day period adding a topical steroid to this regimen while sontinuing to lubricate the eye on a constant basis. I would recommend Lotemax (Bausch & Lomb) or FML (Alcon)  1 drop 4 times a day. MAKE SURE BEFORE USING THIS PRODUCT that the cornea is clear, that there is no bacterial or fungal infections occuring. An appropriate exam by your optometrist, with the slit lamp, will rule out these possibilities. Depending on the evolution of the case, steroids will be tapered over the following days/weeks. Once a topical steroid is prescribed, even if with Lotemax side effects are very minimal, you have to be followed up by a competent eye care practitioner (optometrist or ophthalmologist). This is why your first step would be to consult one of them shortly.

Good Luck,
Langis Michaud, OD, MSc, FAAO
Associate Professor, U de Montréal