New Eye Problems and Having a Corneal Melt
My eyes have proved unpredictable since my chronic dry eye started seemingly overnight in May 2017. Life has been full of curve balls and new treatment plans ever since. Including one day in late August 2020, when I woke up with my right eye swollen, half-shut, and tearing constantly. This was the start of a journey that led me to experience a corneal melt a few months later.
A corneal melt happens when the epithelium, a protective tissue on the cornea, starts to become lost and thin the cornea. It can be caused by things like infection or autoimmune disease. If it’s not brought under control, it can lead to perforation and vision loss.1
This new eye problem caught me off guard
As if dealing with chronic dry eye wasn’t enough, right? When my eye became suddenly swollen and painful, I hoped it was just an infection. That wasn’t the case, however. It turns out that my autoimmune disease had caused inflammatory lesions on my eye.
By chance, I made an appointment with a corneal specialist when my eye crisis began, because my regular eye doctor was on vacation. I’m very grateful that I switched over to his care when I did. My new eye lesions were caused by Thygeson’s disease, which can cause inflammation and thinning of the cornea, and we spent the next several months trying to get it under control.
A complex issue
I was coming into the office 2 to 3 times a month – often having to get a ride because the lesions caused blurred vision. Things got more complex when my Thygeson’s disease was treatment-resistant. The inflammation and my pre-existing dryness started to wear down my cornea, which helps protect the eye.
Ideally, the cornea is constantly lubricated and protected with high-quality tears. I was going through artificial eye drops like never before. After trying 3 different steroid eye drops and putting hundreds of lubricating drops into my eyes, my ophthalmologist decided to put me on Restasis (cyclosporine drops). Thank goodness he did, since it more than likely saved my vision.
The corneal melt
I was still meeting with my ophthalmologist every 1-2 weeks as we struggled to get my eyes back to baseline. About 6 weeks after I began using Restasis, my corneal melt appeared. I knew my right eye wasn’t doing great, but I was concerned as my doctor became alarmed during the exam.
He explained the seriousness of the situation and how urgent it was to get it under control. Corneal melting, or ulceration, can lead to perforation and even vision loss. He immediately got samples of a strong steroid eye drop from his office so that I could start using them right away instead of risking issues with insurance. He would have had me come in the next day, but it was Christmas Eve. So I followed his protocol to the letter and returned 3 days later.
Thankfully, the loss of corneal cells had slowed down. My doctor and I give much credit to Restasis for helping with this process, since it may take weeks to months to fully kick in and I had been using it for nearly 7 weeks at this point. I’m grateful we were proactive with treatment for my inflammation and chronic dry eye. Not all doctors would have started Restasis when he did, but if he had waited we might not have been able to get control of my corneal melt so quickly.
More to the story
Even though we stayed on top of my eye health, acted quickly, and brought the melt under control within a week, I still have a scar on my cornea from the damage. It’s small, but it’s a reminder of the potentially serious nature of any eye problems.
I am convinced my corneal melt occurred due to ongoing dryness and inflammation from my underlying autoimmune disease. This issue continuously damaged the eye. However, it's no coincidence that I experienced the corneal melt less than 2 weeks after I had to pause my systemic treatment (azathioprine) for my autoimmune disease.
At the time, I was pregnant and underwent specialized testing that revealed serious liver toxicity from my medication. So I took a month off of azathioprine and things quickly started to go haywire, including the vicious inflammatory attack on my eye.
An important lesson
My eye doctor helped me advocate for a new medication for my autoimmune disease, since it was clearly an important part of protecting my eye health. The entire ordeal scared me, but it also reminded me of an important lesson: preventative care is often the best care.
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