Dear Doctor,
The following is the response of the Dr.MS Sridhar Expert Panel Cornea :
Thanks Dr. Anil. Pls find below the response
Sub-epithelial infiltrates (SEIs) following adenoviral conjunctivitis affecting the vision, need topical steroid therapy. These lesions are because of host reaction to viral particles. When we start the steroid treatment, it is useful to record the visual acuity and count the number of SEIs, and draw them in slit and diffuse view. This will help us to know the response to treatment and also to know whether any new lesions have appeared.
Response to treatment can be assessed by the lesions fading, no new lesions and by improvement in vision.
In the given case , the response to treatment can be assessed by improvement in vision and also the nature of the lesions. If the edges of the lesions are becoming fussy, it means it is getting better. In case if you are not able to decide whether it is improving, consider recording the visual acuity now, note the number of lesions and edge of the lesions. Continue Lotepred for 1-2 weeks in a dosage of once daily.
Monitor IOP. If some lesions are present at the end of two weeks, you can switch over to a surface steroid like Flurometholone eye drops, 4 times a day for one week, 3 times a day for one week, two times for one week, one time for one week, one drop on alternate days for two weeks and one drop twice a week for two week.
I have tried 0.05% Cyclosporine eye drops twice a day for some patients , but not with remarkable improvement
Though these lesions at times looks scary, eventually it will fade away. We need to resist overindulging in topical steroid therapy. Call the patient frequently for IOP monitoring till you stop steroid therapy
Dr.M.S.Sridhar, MD
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