Her cornea and conjunctiva (white part) were check for breaks and infections. There was none. It can only be inflammation. Good thing only the outter layer of the conjunctiva is inflammed, there is no internal inflammation in the cavity of the eyeball.
With careful questioning of her family and personal health history, the patient admitted that she has a mal-positioned disc in her lower back. It's not a lot of information, but it is a clue. There is a group of people, more in females, that have auto-immune diseases, such as Rheumatoid Arthritis (RA) or Systemic Lupus Erythematosus (SLE). They can easily inflammation on their eyes as well, such as scleritis (inflammation of the white parts of their eyes) Although the said patient have not been diagnosed with RA or SLE, her disc and the eyeball are made of the same tissue, and her sclera was affected significantly. She has Scleritis. (confirmed by Opthalmologist she was sent to)
The best anti-inflammatory medication is steroid, the other choices are nonsteroidal anti-inflammatory drugs (NSAIDs). Scarring can reduce vision in the eyes, steroids are especially useful in eyecare. Of course, with a strong medication, it must take more precautions. The patient needs titration of the steroidal eyedrop and monitoring of the eye pressure. Although long term use of steroids can cause problems, short term use is very effective, provided eye pressures are monitored. There may be other drops she might need to keep the pupil opened up from interacting during the inflammation, and possibly oral NSAIDs.
In the event that a second opinion is needed, or sometimes for the peace of mind for the patient, she/he can be sent to Ophthalmologist for second opinion. I have no problem of sending patients off for close monitoring. It may infact be faster to be referred out from an Optometrist than a family doctor's office in some cases. But if it's a family doctor that started the patients on the steroid, I can monitor the eye pressure for the family doc as well.
In many cases, individuals with scleritis usually have some specific systemic diseases. It's working for the benefit of the patients now that all the Optometrists, Opthalmologists and family doctors are working together to improve their ocular and overall health.
Dr. Yan L. Liang, BSc OD