A 33-year-old white male called for an
urgent appointment prompted by a coworker who became alarmed at his
red right eye. He had no visual complaints. The patient indicated in
his history that he hadn't previously had a comprehensive
eye examination other than screening examinations while in the
military service. The patient had been discharged from the Army
within the last nine months following two oneyear tours in Iraq. He
did admit to reading late into the previous night. The medical and
medication histories were non-contributory. Visual acuity was 20/20
in each eye, and refraction revealed that he needed no correction.
Examination of the lids revealed anterior and posterior blepharitis.
The cornea was clear without staining with the exception of a 2mm x
2mm irregular patch nasally that correspondedto his conjunctival
redness. This area was juxtaposed to an inflamed pinguecula on the
nasal conjunctiva. The conjunctiva was otherwise unremarkable.
Examination of the anterior chamber, iris and anterior lens were
similarly unremarkable in the right eye. The left eye showed similar
findings but to a much lesser degree.
Treating This Patient
pinguecula may result in significant injection - in this case to the
point of observation by a coworker.
patient several treatment options were available. I chose to attack
the blepharitis with Ilotycin (Erythromycin Ophthalmic Ointment, USP,
0.5%) applied to the inferior culde-sac and lids twice per day. My
purpose was to offer some cushioning function from the ointment
vehicle for the cornea and conjunctiva as well as to attack the
patient's blepharitis responded well to the Ilotycin treatment
within two weeks. His pinguecula was still inflamed but not as much.
I decided to have him maintain ocular surface comfort with tear
supplements applied regularly.
Other Treatment Options
Alternative treatment strategies for inflamed pinguecula range from
simply observing the patient to prescribing steroid drops. Others
have recommended lubrication alone, as I chose in this case. You may
consider anti-inflammatory drops in the context of the chronicity of
the condition. Is the patient a steroid responder? If so, consider a
non-steroidal antiinflammatory drug as an alternative. You might
also consider a lower dose of one of the so-called soft steroids
(for example Alrex, loteprednol etabonate ophthalmic suspension
0.2%, Bausch & Lomb). Do think about the patient's financial
resources when making such decisions.
Remember to Follow Up
essential that you monitor the patient with any of these potential
management options. I like to see the blepharitis patients for
follow up in two to three weeks to monitor their progress and change
to another strategy if my initial one fails. Similarly, monitoring
intraocular pressure is essential when using steroid drops.
Loteprednol has less potential to raise IOP in steroid responders
within a six-week interval of use. Nonetheless, with any chronic
condition you must consider the potential adverse effects of