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Riding out conjunctivitis like a bad storm


Among the thoughts I’ve had since the Super Outbreak of tornadoes that hit Alabama on April 27, 2011, is this: if there’s not already an ICD-10 code for “Tornado-induced viral conjunctivitis, bilateral, initial encounter,” there probably should be.

The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

Among the thoughts I’ve had since the Super Outbreak of tornadoes that hit Alabama on April 27, 2011, is this: if there’s not already an ICD-10 code for “Tornado-induced viral conjunctivitis, bilateral, initial encounter,” there probably should be.

There were 62 confirmed tornadoes in Alabama that day, 29 of them touching down in my neck of the woods. The experts had told us it was going to be bad, but around here we’re used to dire weather predictions that never seem to come true. Maybe we were all a little too relaxed when the anaconda sky finally opened wide and tried to swallow us whole.

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The cleanup crew

In the aftermath, we felt rudderless and disoriented.

Most of our region’s power grid had been knocked out, and we all tried our best to adjust to the post-apocalyptic new normal. We sat on our stoops and patios in the pitch black listening to the latest reports on hand-cranked weather radios and inhaling the aroma of neighbors grilling the various freezer meats that would have otherwise spoiled. Our two oldest sons were busy helping with relief in Tuscaloosa, and my wife and I wanted to be like them-useful.

We heard about a cleanup crew that was forming, so we volunteered. Neither of us are “handy” people, but it didn’t matter-all hands on deck were needed, no experience necessary. The big box wholesale clubs and home supply stores had their own generators and were doing a brisk business. We picked up some gloves and a few other supplies. I didn’t have a chainsaw, and you wouldn’t want me using one even I did. But I knew that many salt-of-the-earth country folk would be wielding them lickity split and making it fly. I picked up some boxes of safety glasses because the last thing we needed was stray splinters and perforated globes.

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Our cleanup site was a scooped-out crater encircled with a thorny crown of mangled, grotesque trees and littered with the shattered fragments of houses, hearts, hopes, and dreams. The air was pungent, damp, and heavy with the microscopic remains of faraway places that had rode in hard on the wind like bandits. Tornadoes throw off the balance of things and turn everything upside down; what was there shouldn’t have been, and what should have been was long gone. We inhaled heavily and wiped the sweat from our eyes without even thinking about the rusty, upturned nails, shards of glass, and bad bugs our bodies weren’t prepared to handle.

Next: Hurts like hell eye


Hurts like hell eye

My tornado-induced viral conjunctivitis did as it darned well pleased instead of following the so-called “rules of 8.” It started about four days after we helped with the cleanup, and my left eye was involved the next day. I grabbed a picture of it with my smartphone but had no idea back then that I had just taken what would soon be called a “selfie.” I considered the common lay term “pink eye” and decided that it was a misnomer because it sounds too cuddly, soft, and cute. Why don’t we all just call it what it is-“hurts like hell” eye (HLH)-and leave it at that.

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The power was back up, and I knew I would be needed in the office. But I didn’t want to pass on my HLH eye to anybody else. Optometry Times Editorial Advisory Board member Dr. Tracy Swartz came to my rescue. She was a center director at a comanagement center, and by the time she looked at me behind the slit lamp, I already had some early subepithelial infiltrates (SEIs). I consented to 5% Betadine lavage in order to reduce the viral load and try to get me back to work sooner without causing a HLH pandemic.

I think Dr. Swartz is a strong believer in the old saying, “You gotta fight fire with fire.” She followed the procedure by the book (including a pre-and post- topical non-steroidal anti-inflammatory drug [NSAID]), and it worked. The chemosis and injection decreased dramatically. To be on the safe side, I waited a couple of days to return to the office, but I then proceeded to see patients while gloved up and disinfecting meticulously. Good thing, because I had to remove a few foreign bodies from the salt-of-the-earth country folk with the chainsaws.

Next: Ride it out like a bad storm


Ride it out like a bad storm

But even with the topical NSAID and preservative-free artificial tears onboard (plus an “occasional” drop of prednisolone acetate 1% that I keep around for “special occasions”) the stinging was noticeable for a day or two afterward. I had even dryer-than-usual eye for a few weeks after that. Everything has consequences. Betadine lavage may work and might be a good option for someone who has symptomatic SEIs or can’t afford to lay low until they’re no longer contagious. But I found the weeks-long extra dry eye to be a significant trade-off.

Since then, I’ve had several occasions to consider using Betadine lavage on my patients, and I’ve always explained to them that it’s an off-label use with its own side effects. I make sure they know that we lack well-designed clinical trials and that the evidence for its efficacy is anecdotal.

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If they’ve managed to stay with me through all that, I then tell them my own little anecdote. It seems that it’s my lot in life to experience every ocular malady known to man and then tell scary stories about them.

That’s the moment when they really perk up and listen. Some patients proceed with the treatment. Others decide to just take their chances and ride it out like they would a bad storm.

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