Day 1: A 30-yr old male walks in with a nasty red, extremely painful eye. He has several subepithelial infiltrates, presumably from CL (AVO) overwear. We treated him with tobradex qid x 7d.
Day 7: No resolution from the tobradex. Pain is worse now, SEIs remain, now on both eyes. He says it started getting better, so he tried wearing his CLs again, and the pain returned with a vengeance. We gave him Pred Forte to use q1h x 1-2d, then qid x 1 week
Day 14: Eye is still red, still extremely painful. Patient is really frustrated. Turns out he used the whole bottle of Pred Forte in 2 days (ridiculous, I know). Eye felt better for a little while, then redness and pain returned worse than ever. Since SEIs can rebound from steroids, we gave him Pred again, with strict instructions to taper slowly over 1 week.
Day 21: Patient no-showed for 1-week FU.
2 weeks later: Decided to call the patient to make sure all was well. Patient reports no improvement; he has been living with his red, painful eye for over a month now, and can't get any relief. Says he didn't come in because he can't afford to. We offer to see him free of charge to see what is going on.
Patient shows up with classic Thygeson-looking SPK OU - no more subepithelial infiltrates now. Steroids obviously haven't worked for him, so we put him in a bandage CL (Focus N&D) - the doc I'm working with says this has worked for every case of Thygeson's he has ever seen.
1 week later: patient only wore the CL for 2 days, because he had pain when inserting it for 30 sec or so. After insertion though, it felt great. Classic Thygeson SPK is still there, but even more diffuse now OU. We educated him about the exacerbation-remission cycle of Thygeson's - there is nothing more to do after steroids and the bandage CL, unless we want to do chronic low-dose steroids, for which the patient has no money or desire. We sent him home and told him to wear the CL more frequently, as long as the eye isn't red or painful after the initial insertion - we'll see him back again in 3 mo.
I have no idea how he morphed from SEIs into Thygeson's. I wish I had taken photos. Weird.
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