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Dr. JLB
Dr. JLB, Ophthalmologist
Category: Eye
Satisfied Customers: 86
Experience:  General Ophthalmologist, Fellowship trained in Refractive Surgery
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I have an eye infection caused by serratia marcescens from

Customer Question

I have an eye infection caused by serratia marcescens from possible soft lense solution contamination. My opthamologist doesn't communicate very well so I am not sure he knows how to treat it. He put be on gentamicin drops 6 times a day for 3 days and now I am on 4 times a day and will go back to see him in two days. My eyes are the same--no better; no worse. He made the statement that this bacteria doesn't usually show up in the eyes. Other than that, he didn't say anything. I would like to know if I need to see an infectious disease doctor or if I should stick with him for another couple of days.
My eyes are extremely red--and still watery and mattering in morning.
I have also read that this bacteria is resistent to gentamicin--what are your thoughts?

THANKS
Becky
Akron Ohio
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. JLB replied 5 years ago.

Hi Becky,

 

First, I would like to encourage you to push your ophthalmologist to educate you regarding the condition and share his treatment plan with you. This may give you more confidence in his ability or lead you towards a second opinion. If the thought of a second opinion crosses your mind, then you should get one. A new perspective on the situation usually helps.

 

Serratia marcescens is not a common bacteria in the eyes. When it is found it is usually related to contact lens wear. This is a gram negative bacteria that can be resistant to a number of antibiotics. Theoretically, gentamicin should work properly. Gentamicin is a good alternative to treat gram negative bacteria.

 

If you have not seen an improvement, then the possibility exists that the bacteria is resistant to the medication and coverage with another antibiotic may be necessary. Furthermore, there is a chance that you are dealing with more than one bacteria.

 

I usually place my patients on fourth generation flouroquinolones (vigamox or zymar) or broad spectrum fortified antibiotics with very frequent instillation. You could mention this to your ophthalmologist to see what how he feels about this. If you do not feel comfortable with this, you should seek a second opinion to see what the new doctor suggest for treatment.

 

Remember do not wear contact lenses as you go through this process and throw away the contact lenses, case and solution.

 

I hope this is helpful and good luck....

 

Sincerely,

 

Dr. JLB

Dr. JLB, Ophthalmologist
Category: Eye
Satisfied Customers: 86
Experience: General Ophthalmologist, Fellowship trained in Refractive Surgery
Dr. JLB and other Eye Specialists are ready to help you
Customer: replied 5 years ago.

Dear Dr. JLB,

 

Thank you so much for your response. It made so much sense to me, I went to see another Opthalmologist and he was much better at explaining in detail what was going on in my eye--infection of the glands, stopped up ducts and he suggested that I go on an oral antibiotic. The weird thing was that he said he wasn't that concerned about the small amount of serratia marcescens. Meanwhile, my eyes are getting redder and more infected. I definitely think the gentamicin or the cefuroxime (oral and also suggested to me my an infectious disease doctor (who my general doctor called).

 

I am at the end of my rope. 2 Opthamologists--neither of whom have ever seen this nor dealt with serratia m in the eye before. Can you possible recommend one in Akron, Ohio that may know more about it as well as zymar that you mentioned?

 

Is it that rare? Why would the lab tell my Opthamologist to use gentamicin if they know serratia is resistent to it?

 

THANKS.

 

Expert:  Dr. JLB replied 5 years ago.
Hi Becky,

I'm glad you decided to obtain a second opinion. Unfortunately, I do not know any ophthalmologists in your area. I do know that the Cleveland Clinic is one of the best know in the nation with regards XXXXX XXXXX so you may want to inquire about a good ophthalmologist there.

Serratia is relatively rare, but not unheard of. It appears to me, that the second ophthalmologist you visited is more concerned with a condition called blepharoconjunctivitis. This infection involves both the eyes and lids.

I prescribe an oral antibiotic named doxycycline to treat blepharoconjunctivitis. This usually offers excellent results. In addition, I prescribe antibiotic ointment (ciloxan) for nighttime use and lid scrubs to the base of the eyelashes with Johnson's baby shampoo.

The lab may have recommended gentamicin because in theory it should work on serratia, although resistance is possible.

I hope the new treatment begins to work soon, and if you are not satisfied with the first two doctors then move on to a third, However, don't do this until you have given the treatment a good chance to work.

Once again, best of luck as you search for the correct advice and treatment...

Sincerely,

Dr. JLB
Customer: replied 5 years ago.

Dr. JLB,

 

Thank you for your quick response. I did make an appointment with an ophthalmologist who has expertise in infectious disease of the eye but she can't see me until July 6th (I was advised to call daily in case of a cancellation. I have this appointment as a backup. Meanwhile, I will see my opthamologist on monday and though he is the most uncommunicative person I have ever met in my life, your email reponse has given me the confidence i needed to ask about the possibility of my infection resisting the gentmicin and his thoughts on the two antibiotics your suggested, vigmox or zymar. Also, do you know how quickly this microbe grows? it was listed on the lab report after the word, rare. Not sure if this means found rare in the broth or that it is rare?

 

Is it ok for me to ask him to re-culture (or whatever its called?)

 

THANKS, XXXXX XXXXX You are my life-line right now.

 

(I don't want this for a life-time and I get scared when I read this stuff on the internet)

Expert:  Dr. JLB replied 5 years ago.
Hi Becky,

The internet can be a scary place. You will easily find the worse case scenario in most conditions that you look up. This does not mean that such consequences will affect you.

In my experience, this microbe grows realitively slowly but can, at times, be difficult to treat. Vigamox and Zymar usually provide broad coverage for many bacteria, this can include Serratia. The best alternative is to have the lab that reported the positive cultures, provide a report on the antibiotics that this particular strain of serratia is sensitive to. This can be obtained a few days after the positive culture. This information will make the infection easier to manage.

Don't forget, you may also need to treat the blepharoconjunctivitis to achieve full resolution of your symptoms.

I hope this is helpful...

Sincerely,

Dr. JLB
Customer: replied 5 years ago.

Dear Dr. JLB,

 

The second ophthamologist said that my glands, ducts had purulent dicharge but that it was like butter (its supposed to be more fluid?)--and at an extreme. My eyes not only look red but the botXXXXX XXXXXds feel inflamed and itchy.

 

He suggested that I use warm compresses in addition to taking mintocin (sp?); the fist eye doc said don't because he didn't want the warm compression to cause infection...not sure why that would be.

 

Anyway, today, my tucts and lids are more itchy and inflamed than ever so I put a warm cloth on my eyes for about 10 min. and my eyes watered a little then felt better for a while. Also, I washed my face and eyes a little with "purpose". They seem to feel a little better when I wash them.

 

Also, my gp talked with the infec disease doc who suggested I get on cefuroxime to kill the serratia which he thought was causing the tear duct infection. (so I wasn't sure which adice to listen to so went with the cefuroxime for now and after things get cleared I may go back to ophth. 2 who is very good at explaining things and is consistent with your thinking on treating my gland problem.

 

Is there a way to get these glands unplugged from this "butter" consistent plugs--they are driving me nuts and maybe they would at least feel better--even though my green eyes are now RED (not pink).

 

Best regards,

Becky

 

 

Also

Expert:  Dr. JLB replied 5 years ago.
Hi Becky,

Cefuroxime is a good choice for systemic treatment of serratia. I'm not sure how much benefit it offers for treating positive eye cultures for this bacteria.

Your description confirms that the second ophthalmologist you visited diagnosed blepharoconjunctivitis. It is difficult to determine what type of compress is best to use, hot or cold. Hot helps the glands open up and drain their secretions better, while cold will decrease inflammation and offer instant relief. The hot compresses will help the condition resolve a little faster but the cold may help you feel better.

Johnson's baby shampoo is best when doing the lid scrubs. Remember to scrub at the base of the lashes, right where they enter the lids. Also, I hope that MD #2 provided a prescription for an antibiotic ointment (Ciloxan or Tobradex) to use at night. This helps significantly.

God Bless,

Dr. JLB

ps - the "rare" in the lab report meant that not many organisms grew on the culture. This is the reason blepharoconjunctivitis is likely the major culprit for your symptoms.
Expert:  Dr. JLB replied 5 years ago.
I hope you saw the "ps" I added to my last response...

Dr. JLB
Customer: replied 5 years ago.

Dear Dr. JLB,

 

Wow, this eye puzzle is coming together for me now. MD # XXXXX did not prescribe a night time antibiotic ointment nor did he mention the "scrub" but he did prescribe the oral minticin (sp). So I will definitely bring this up to MD # XXXXX at my Monday appointment.

 

And, I will do a diluted baby shampoo "scrub" tonight.

 

Also, very interesting on what the word, "rare" meant on he report and now I understand why MD 2 was really concentrating on getting the blephaorconjunctivitis cleared up...he said he wasn't sure what caused it but that I had it (wasn't sure if the serratia caused it).

 

Last question, it seems that all of this eye problem stuff started when I was having severe hot flashes 3 months ago--everytime I had a hot flash my eyes would water. then I had a test that showed I had dry eyes...then 5 weeks ago I took a business trip to China and I think i used renu multi pur sol everyday to clean my lenses in the same case for 10 days...

 

Anyway, could menopause have something to do with the gland prob?

 

(not sure where the serratia came in unless it was the contact solution/case.

 

Thank you.

I feel like I am on the road to understanding this so much more--its been 2 months of me seeing doctors, but this is the first time I actually got to talk to one that was willing to explain the details. You are an angel.

Good night.

Becky

 

 

 

Expert:  Dr. JLB replied 5 years ago.
Hi Becky,

Menopause doesn't cause bleoharoconjunctivitis or have a direct link to the serratia positive cultures. However, dry eyes do cause inflammation in the eyes which, when compounded with a blepharoconjunctivitis, can make the symptoms worse.

There is a direct link between menopause and dry eyes. The hormonal change will decrease tear production. Decreased tear production exposes the surface of the eyes which in turn become inflammed. The inflammation then worsens the dry eye, and so on...

The tearing you experienced prior to the diagnosis of dry eyes was a reflex to the dryness. The brain detects the dryness and immediately sends signals to the eyes to increase tear production. These tears are not effective as their composition is too aqueous and they continue to evaporate quickly or fall right down your cheeks.

I will say that, dry eyes do cause microscopic defects on the cornea which can provide an entry point for bacterial infections. These infections normally involve corneal ulcers. Since this has not been part of your clinical picture, it is doubtful that serratia could have used this avenue to achieve an infection.

I believe that blepharoconjunctivitis is the principal cause for your symptoms and it may be independent of the serratia positive culture. By properly treating the blepharoconjunctivitis, you will find significant, if not complete, relief of your symptoms.

You may use artificial tears, along with my other recommendations, to provide some relief while you heal.

The contact lens solution may have been contaminated, but, serratia is ubiquitous in the environment; so there are many sources it could have come from.

Good Night,

Dr. JLB
Customer: replied 5 years ago.

Dr. JLB,

 

Thank you so much for your expertise and your incredible ability to articulate so well.

 

Becky

Expert:  Dr. JLB replied 5 years ago.
Your welcome!

Dr. JLB

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