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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3152
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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We came from US to Doha, Qatar recently. The quality of health

Resolved Question:

We came from US to Doha, Qatar recently. The quality of health care is not always the best here. On the 4th of May I came down with Shingles, 6 days with no symptoms except severe headache and after 6 days with blisters on the right side of my forehead, behind right eye, right eyebrow and one blister on the inner corner of my right eye lid. Then the doctor immediately prescribed Famvir 250 mg but the severe headache was continued for about 2 weeks. I was visited by Neurologist and he diagnosed I have got Postherpetic Neuralgia and I started taking Tramadol 50 mg/2 tablets twice a day - Lyrica 75 mg/1 morning, 1 noon and 2 at night and Amytryptiline 25 mg/one tablet/night. These medications went on until May 23rd but I stopped Antiviral after 10 days. Then I visited by Ophthalmologist because of a little discomfort in my right eye. He found my right eye's pressure high and immediately prescribed Acyclovir 400 mg/2 tablets twice a day and Prednisolone Acetate 1% eye drops every one hour and recommended hospital admittance the next day for Antiviral IV for 3 days and then I stopped Tramadol a week after I was discharged from the hospital but I continued Lyrica and Amytryptiline the same way but for Acyclovir 800 mg 5 times/day for 10 days. Then again I had to continue Acyclovir 800 mg/twice a day. Two day after I ran out of my Antiviral I was visited by Opthalmologist that I thought the doctor would take me off anyway. I felt very short moment of poking pain in my right eye. When I went back to Opthalmologist, the doctor said you should have not stopped it and pointed out I can stop Lyrica and Amytryptiline but I must continue Antiviral for about a year or anytime the virus can attack and can go to the other eye as well. When I pointed out how expensive the Antivirals are and my insurance does not cover medication, he reduced the Antiviral dosage to 400 Acic twice a day for a week and then 2-4 weeks once a day until I go back to him again. For the last few days onward I still feel periodic stabbing pain on my right eye even now that I am still on Antivirals. My question is, should I really be on antiviral medication for a year? On what dosage and how many times a day?
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 3 years ago.

Doctor DanB :

Hello and thanks for your question. Are you available to chat?

Customer:

yes

Doctor DanB :

Thank you for your detailed history...

Doctor DanB :

From what you've said it sounds like you have had a keratitis, or infection of the cornea from the shingles virus.

Doctor DanB :

To treat this does require several days of the 5x/day, 800mg antiviral that you had.

Doctor DanB :

Studies have shown, though, that to prevent a recurrence of the virus in the cornea, as well as decreasing the chance of the other eye having this (a separate event), being on prophylactic antiviral for the 1st year after the corneal infection is the best thing.

Customer:

yes but this doctor in Qatar is telling me I need to stay on Antivirals for at least a year

Doctor DanB :

The does for this is usually 400mg twice daily.

Doctor DanB :

There are research studies that show that this is the best treatment protocol to prevent recurrences in the same eye, which can often times be more damaging than the initial infectious episode.

Customer:

What is the average time that the pain continues in the eye?

Doctor DanB :

The pain is variable. If the pain you're referring to is intermittent sharp, stabbing pains, or foreign-body sensations, this is variable, but usually doesn't last too long. These types of pains can be helped by using artificial tears 4x/day. If the pain you're referring to is deep-seated, aching or pressure type pain, this usually goes away once the inflammation is successfully controlled and your doctor should be able to determine whether this is the case or not. That's why they prescribed the steroids to help control the inflammation.

Customer:

I had the stereoids eye drop but the last time I visited by Opthalmologist he said the eye pressure is ok

Customer:

my pain is not pressure type but I guess it is deep-seated stabbing type

Doctor DanB :

It isn't always the pressure that causes eye pain. More often than not, it is just the inflammation itself which can cause the achy, pressure-type pain. Sometimes the inflammation can cause a stabbing type of pain, but if it is a deep pain, this is more likely inflammation related. If it is more of a superficial pain, this often relates to irritation on the cornea itself, which usually responds to using artificial tears 4x/day. I would recommend going ahead and using some artificial tears in this manner, but they have to be done consistently to work.

Customer:

is that ok to stop Lyrica & Amytryptiline?

Doctor DanB :

The Lyrica and the Amitriptyline are for the very painful skin lesions that you had. Assuming this has stopped and your primary doctor hasn't instructed you otherwise, then I think it would be reasonable to stop these, but if you're in doubt, I would ask your primary doctor first.

Customer:

thank you very much for your help doctor

Doctor DanB :

You're welcome. Do you have any other questions about this that I can help you with?

Customer:

I just wanted to confirm since this has been going on since late April and medical here is such that I wanted a second opinion. The skin Leisons have healed for the most part although there are marks left but the pain periodically continues in the eye and general area. So I wanted a second opinion

Customer:

You seem to confirm with this doctor has said

Doctor DanB :

Okay, I hope it's been helpful.


I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.


 


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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3152
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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