Corneal ulcer

[bleeny]

I've just got back from the local minor injuries unit as I have what looks like a blister on my eyeball. The Nurse Practitioner diagnosed a corneal ulcer. She says she thinks I have dry eyes - is this quite common with SLE? Should I contact the rheumatology department or GP regarding the dry eyes? I have antibiotic drops in the meantime.

[Hidden]

Yes, talk to your doctor. You might possibly have Sjogrëns as well as Lupus. But definitely have it checked and let us know how it turns out for you!

[bleeny in reply to Hidden]

Thank you - I'll let you know what happens.

[Hidden in reply to bleeny]

🙏

[Foggyme]

Bleeny - first, yes dry eyes are common in SLE (I have them too) and can be present even if you don't have Sjogren’s.

Did the nurse practitioner suggest referral to an ophthalmologist? This would be usual for someone with SLE and eye issues (including dry eyes) and in particular, with a corneal ulcer. Your GP or your rheumatologist can refer you. SLE plus a corneal ulcer should warrant an urgent referral.

It would be a good idea to let your rheumatologist know what's happened - perhaps there's a telephone helpline you can do this by. Or contact details for their secretary? Ongoing support can be obtained from your GP - who would most likely want to re-assess your eyes and send you to eye casualty if they had any concerns.

In the meantime, if your eye gets worse in any way at all (pain, swelling, visual changes etc.), might be a good idea to go to a large A & E department that has an eye casualty attached. You'd have instant access to an ophthalmologist who would assess and further treat your eye (if necessary) and also refer you direct to ophthalmology out patients services for ongoing care. If you're worried, another option would be to see an optician who could advise whether it is necessary to go to eye A & E (can't remember if an optician can refer direct to an ophthalmologist but someone else may pop up with that answer).

You don't mention if you're on any medications but if you take steroids or immunosuppressants the corneal ulcer and potential infection will need monitoring closely. Also worth noting that infection is not the only possible cause of corneal ulcer - very dry eyes (among other things) can cause this too - so dealing with the dry eye issue may be essential to prevent further corneal ulceration - and if your ulcer is cause by dry eyes, then antibiotics are not likely to fully address the underlying cause (hence the necessity for referral to an ophthalmologist for appropriate assessment and ongoing treatment plan (if necessary).

Corneal ulcers can be a serious problem so if anything does get worse (even a little bit) please don't be brave and try to 'tough it out' - it would be advisable to get immediate medical attention. Not saying this to worry you - it’s just that fore-warned is fore-armed...and I have to say I'm a little surprised that the nurse practitioner didn’t send you to eye casualty where a eye doctor can do a more thorough examination and assessment of your eyes... especially because of the SLE.

Sorry this is happening to you. Eye issues can be incredibly painful and quite frightening too. Hope things improve quickly and you that you get appropriate follow-up and ongoing care.

My brilliant ophthalmologist has worked really hard on my eye issues (no tear pools and acute on chronic blepharitis) and they’re much improved since I've been seeing him.

I'm a Lupus baby compared to many folk here, so others may pop along with more specific advice and/or information or suggestions 😉.

Good luck. Let us know how it goes xx

[bleeny in reply to Foggyme]

Gosh, what a detailed reply - thank you. I have completed an econsult form with my GP and should hear back on Monday. I agree with you that the dry eyes should be addressed - the Nurse didn't mention seeing an Ophthalmologist surprisingly. Fortunately I'm not on steroids or immunosuppressants yet, just hydroxy.

[Bearess1993 in reply to bleeny]

Hi Bleeny. I don’t want to alarm you but I have had corneal ulcers and they usually need more than antibiotic drops. Please go to an emergency department with specialist eye dept. My GP tried to go I’ve me an antidepressant as they thought I was imagining the pain. They told me to come back in two weeks if I still thought I had pain ! The eye emergency dept were very concerned I left with about 4 different drops and a supply of antibiotics for about 6 weeks. I had 3 ulcers at that point. Hopefully that will not happen you but definitely please see an expert

[bleeny in reply to Bearess1993]

Thank you for your concern. I think I'll wait to see what the GP says on Monday in response to my econsultation. The 'blister' (or what the Nurse called a fluid filled vesicle, in addition to the ulcer) doesn't seem to be going down, so I think I'll ask for a referral to the emergency eye clinic at the main hospital. I looked online at their website and it seems I need a referral rather than just turning up.

[Sekka in reply to Bearess1993]

Excellent and essential advice! I had very specific treatment when I went through all of this so I also know how important it is for us- Bleeny please be very careful and don't let the system defeat you! 👍 Good advice from Bearess!

[bleeny]

Hi. I have been tested for Sjogrens - the anti-Ro was negative but I don't know if that is absolutely definitive??

[Sekka]

Contact rheumy and GP.

I have Sjogrens and the severe dry eye problem gave me a series of corneal ulcers some years ago. It doesn't happen any more because I'm over the top cautious plus plus!! I use eye drops about every 2 hrs and some viscous ones when they don't quite do it. (Sometimes my eyes are gritty as well as very dry) At night I use eye ointment which I clean off in the morning with a warm damp facewasher and then I start the process again. I swear I could put in eye drops while standing in a slow moving bus queue!

I suffered so much with the eye ulcers that this routine became essential. Glare bothers me too at times so often I have sunglasses on when others don't but it works for me. Try being this diligent and it should prevent the eye ulcers.

Use artificial tears eye drops if you have to wait long for an appt. Have a chat with a pharmacist in the meantime and let us know what is suggested. Poor you, I know how painful and scary it can be. Best wishes!

[bleeny in reply to Sekka]

Yes, it has scared me a bit as vision is so precious. You sound very disciplined with your eye care routine - I will have to follow your example as I don't want this happening again!

[Sekka in reply to bleeny]

Yes being diligent has paid off. My eye specialist is very complimentary about the care I take but as I have said to him I'm too scared to stop! Keep up the good care! 😊👍😎

[Bearess1993 in reply to Sekka]

Hi Selma. I love your comment about the bus I know what you mean. I can put eye drops in with my eyes closed 😁. Seriously though the sunglasses are a big help. I wear them as much as possible

[cathylou]

I've had this and it was due to dry eyes. It was incredibly painful. I now regularly use creams from the gp which helps xx

[Hooray37]

i had dry eye for twelve years using all kinds of over the counter drops. Worked

for a time. I go to Wills Eye Hospital in Philadelphia and they as a last resort

prescribed Autologus Serum Eye Drops. I did it and it has literally been a

miracle for me. I started in March 2019 and to date have not used any over

the counter products. Google Autologus Serum Eye Drops for more info to

show your doctor. Feel free to email me ([e-mail]) if I can be of

any more help.

Best Regards

Maureen

[Shejustice in reply to Hooray37]

I have had severe problems w my dry eyes, have Been prescribed the serum tears and it is a miracle! Taking them for last 4 weeks and very helpful . I am so thankful to be able to see