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