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Advice for a problem with eyes


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I realise that this is a problem which an eye specialist should deal with, but communication with my Spanish GP and anyone he might refers me to is difficult and frustrating, and he dismisses my problem as unimportant. It is an on-going and increasingly annoying itching which re-occcurs at what seems like regular intervals of about once a month. It starts off with the sensation of having some dust in the eyes - (this is actually not a surprise because the climate here in Tenerife is extremely dry, rainfall is very low, humidity is very low, and there is a lot of dust around. In addition I keep myself busy with light building work, so sawdust is a problem, and we keep chickens and their bedding straw is dusty.) The itching becomes intense, with all the skin around the eyes very dry and tender. Application of moisturizer does  help but clearly does not solve the underlying problem. Anyway, the itching becomes so severe over a few days that I can't function. Some time ago I complained to the GP that his recommended eyedrops for dry eyes were ineffective, and he very reluctantly prescribed antibiotic drops (Colirio). These solved the problem within an hour. Since then, the condition has ocurred twice, both times I endured it for a few days than applied the antibiotic drops which again solved the problem instantly.

When this started, the GP explained that antibiotics were useless because their effectiveness decreases rapidly with use, and that eventually they would have no effect at all. Not being a biologist, I don't understand what is happening.

Am I correct in deducing that if the antibiotic drops are instantly effective, there must have been a bacterial infection? Why would this happen at regular intervals, and why do my eyes not have a mechanism for dealing with it? What is the possible underlying cause? Any advice appreciated.

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You have to complete the course of antibiotics or you risk developing an antibiotic-resistant infection. Antibiotics only kill some of the bacteria with a single dose. Killing them all requires multiple doses. i.e. you don't stop just because you feel better.

!

Moderator Note

As for diagnosing your affliction: we don't do that here.

 
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https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

This story made a splash a month or so ago. It seems to contradict your claim (which is received wisdom of course)

 

and   http://www.bmj.com/content/358/bmj.j3418  (from the well respected British Medical Journal. )

 

 

"With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message, argue Martin Llewelyn and colleagues"

Edited by geordief
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Yes, I know we don't do diagnoses, but suggestions might help. The GP prescribed the antibiotics in the first instance, a 10 ml bottle, and I took the drops for one week as directed. That still left me with over half a bottle, so the second time I took drops for a shorter period. I still have some left, but not much, so the issue of the truth of received wisdom is  of great interest to me. If the drops kill most bacteria, I can't see why a whole week is more beneficial than (say) a couple of days. 

My greater issue is understanding what is going on. The GP dismissed my own guess at conjuctivitis, but after some research I realised that the Spanish definition conjunctivitis is  much more restricted than the English usage, but I don't really understand the difference. So both I and the GP might be right in our own languages.

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Tears contain lysozyme which breaks down the cell walls of certain bacteria. It  has an antiseptic function. Obviously, it needs a liquid carrier to distribute around your eyes and if your eyes are in a persistently dry state from the atmospheric conditions the lysozymes effectiveness is reduced, they are going to be more vulnerable to infection, especially with micro-abrasions from dust as well. Perhaps you could take a break in an environment that has more humidity/less dust so they can recover and possibly, if your doctor thinks so, do that treatment again in that more humid environment.

Quote

Lysozyme, also known as muramidase or N-acetylmuramide glycanhydrolase is an antimicrobial enzyme produced by animals that forms part of the innate immune system. Lysozyme is a glycoside hydrolase that catalyzes the hydrolysis of 1,4-beta-linkages between N-acetylmuramic acid and N-acetyl-D-glucosamine residues in peptidoglycan, which is the major component of gram-positive bacterial cell wall.[5] This hydrolysis in turn compromises the integrity of bacterial cell walls causing lysis of the bacteria.

Lysozyme is abundant in secretions including tears, saliva, human milk, and mucus. It is also present in cytoplasmic granules of the macrophages and the polymorphonuclear neutrophils (PMNs). Large amounts of lysozyme can be found in egg white. C-type lysozymes are closely related to alpha-lactalbumin in sequence and structure, making them part of the same family.[6] In humans, the lysozyme enzyme is encoded by the LYZ gene.[7][8] https://en.wikipedia.org/wiki/Lysozyme

 

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Thanks - that's very helpful. I have noticed that it has not happened when I am elsewhere where it is more humid, although I don't spend enough time away from home to be sure that there is a connection. I'm off to the UK next week, so I can see whether I get a couple of weeks of humidity and make a difference.

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Eye sprays?

 

https://www.youtube.com/watch?v=XUiDpywMK4E

A bit tangential but once I got dead millepedes' body fluids on my fingers  which I rubbed into my eyes. (from working in the garden)

 

They were chronically  dry for a week or so until I worked out what it was. Perhaps clean your hands whenever you have had them anywhere doubtful. It cannot do any harm.

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1 hour ago, geordief said:

Eye sprays?

 

https://www.youtube.com/watch?v=XUiDpywMK4E

A bit tangential but once I got dead millepedes' body fluids on my fingers  which I rubbed into my eyes. (from working in the garden)

 

They were chronically  dry for a week or so until I worked out what it was. Perhaps clean your hands whenever you have had them anywhere doubtful. It cannot do any harm.

Yes, thanks - I do have a bottle of that eye spray, and I use it regularly. I have not been able to detect any positive effect, and the spray is quite expensive. As for hands, I used to own a farm, so am quite used to washing my hands very often. I also try to avoid all contact between hand and eye, although this is not easy during the night if they itch.

 

What I would like to know is the mechanism by which a bacterial infection actually causes itching which is effectively pain because it's so severe.

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5 hours ago, DrKrettin said:

If the drops kill most bacteria, I can't see why a whole week is more beneficial than (say) a couple of days. 

It generally does not. In a single application you just kill off a given proportion which can grow back once the treatment stops. Even worse, resistant subpopulations may start outcompeting sensitive strains. Short or underdosed treatments increase the chance of this happening and at some point resistant strains will be dominant, at which point medication will be ineffective. As such, antibiotics really should only be used when really indicated and if used, the aim is to kill everything off as thoroughly as possible.  Moreover, harmful bacterial infections often (though not always) get progressively worse and typically have a mucoid discharge. As such, bacterial infections are usually somewhat easy to diagnose. 

I am wondering whether you have tried antihistamines first. 

Edited by CharonY
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5 hours ago, DrKrettin said:

If the drops kill most bacteria, I can't see why a whole week is more beneficial than (say) a couple of days. 

Because it will kill the more-resistant bacteria as well

This is likely not beneficial to YOU, however, if more-resisistant bacteria survive,

we can't treat that bacteria with the same antibiotics anymore in the future.

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51 minutes ago, DrKrettin said:

Oh yes, I've tried antihistamines, and suffered the sensation of terminal fatigue when it was really not safe to drive a car or even go for a walk.

I was more thinking in terms of eye drops and non-drowsy formulations.

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11 hours ago, StringJunky said:

You could give your eyes a sauna by putting your towel covered head over a sinkful/bowlful of  hot, steaming water occasionally until you get back to the UK.... don't scald yourself. 

I hadn't thought of that - and I've done it often enough for sinus problems in the past. I'll give it a try.

11 hours ago, CharonY said:

I was more thinking in terms of eye drops and non-drowsy formulations.

I didn't know you could get antithistamine eyedrops!  I'll investigate, thanks.

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