Contact lens wear can be an inflammatory influence under normal circumstances, but an alreadysensitized cornea can show rebound inflammation if proper steps aren’t taken. It is imperative to use the immunosuppressive benefits of steroids with a slow taper as contact lens wear is resumed, or the patient will suffer setbacks and require multiple office visits. We typically restart limited contact lens wear when the rehabilitating cornea can tolerate a limited steroid dosage of once to twice daily.
On the other hand, Dr. Sheppard reports successful outcomes when using cyclosporine in patients with dry eye who have pure aqueous tear deficiency. For patients with dry eye accompanied by redness, blepharitis, significant tarsal changes, or ocular allergy, he administers induction therapy with a topical steroid at one visit and then maintains them on cyclosporine for the long term. Once the patients are in a successful maintenance phase, Dr. Sheppard recommends that they use their steroid for acute flare-ups triggered by travel, allergies, respiratory infection, or exposure to environmental irritants. His steroid of choice for this indication is loteprednol.
Management of acute endophthalmitis requires a rapid diagnosis and appropriate treatment or referral. Most cases of endophthalmitis are managed by vitreoretinal specialists who will take a sample of fluid from the eye for culture and inject antibiotics or antifungal agents into the eye on an emergent basis. In cases of light perception vision only, vitrectomy is recommended in addition to culture and antibiotic injection. Cases of endophthalmitis can lead to a complete loss of vision and even the eye if not treated rapidly. However, it is possible to retain good vision if treatment is timely and successful.