inflammation =/= "infection"

We medical professionals sometimes take for granted that patients know the differences between viruses and bacteria, and between inflammation and infection. I have come to realise that in actuality very few people who are not in the medical profession understand these differences. Here's a quick rundown (mostly related to eye care since that's what is relevant to this blog): 1) INFECTIONS: caused by a virus or a bacteria or fungus, etc GROWING in, on or near your eye, usually contagious (but not always as in the case of say bacterial ulcerative keratitis), and usually needs to be treated with anitbiotics or antivirals or antifungals, etc. Some common eye infections are epidemic keratoconjunctivitis, microbial keratitis (actually not that "common" but frequently mentioned in the literature), herpes simplex keratitis, bacterial conjunctivitis, etc. There are, of course, a few other rare eye infections that are caused by multicellular organisms like toxoplasmosis or by amoeba as in acanthamoeba keratitis. To "kill" infections we need drugs that KILL these organisms. Infections are out-of-control growths of FOREIGN ANIMALS (technically viruses and fungi are not "animals" but still) that need to be KILLED. INFLAMMATIONS: these are totally different. They are NOT caused by some living microbe GROWING in/on your eye, and therefore do not need medications that KILL bacteria, viruses, fungus, etc. They are reactions that your body has to some insult/irritation/allergy. These are your own body's response and in the case of eyes include swelling ,pain, redness, light sensitivity, etc. Infections can CAUSE inflammation, but an inflammation is not the same as an infection. Therefore inflammation is not treated with drugs designed to KILL MICROBES unless there is an infection. In the absence of infection, inflammation is treated with anti-inflammatories like STEROIDS, not antibiotics to kill bacteria, for example. Some common eye inflammations (not infections!) are pingueculitis, episcleritis, iritis, punctate keratitis, infiltrative keratitis, etc. I realize to a patient these "all sound the same", but they are not, nor are they the same as "infections". The big hang up, of course, has to do with "pink eye". Every patient who comes in with a red, painful, watery, irritated or light sensitive eye assumes it's "infected" and they have been conditioned by most of the medical community to think that they need antibiotics. Some of them are infected, but I find that most of them are not. Most of them are INFLAMED. I Rx way more steroids for inflammation than I do antibiotics and antivirals for infection. "Pink eye" is one of the top reasons for people to go to the doctor, miss work/school, etc and consequently antibiotic eye drops are some of the top selling medications. But a bunch of these "pink eye" cases are, in my estimation, misdiagnosed and mismanaged. One cannot assume that a red eye is an infected one and that antibiotics are warranted. I just stated that I am Rx'ing more STEROIDS than antibiotics, so in my estimation more red eyes are inflamed than infected. Way more. I've said this before but it bears repeating: if you have an eye problem, go to an eye doctor. You know what you're going to get if you go to the primary care doc with an eye problem: antibiotics. But is it an infection? Its probably not. Its probably inflamed.


  1. Hi,
    Recently I went in to the OD for a new rx and check up and she said that I had an infection in both eyes and inflammation.

    I honestly hadn't noticed anything unusual prior to going in, my vision had been a little blurry and felt tired but I was studying a lot and sleeping less and I needed a new rx so i was shocked when she said this.

    I have been wearing contacts for over 10 years, and I have been wearing acuvue oasys biweekly ones for the past 7. My normal routine would be to put them in first thing when I woke up and wear them all day (up to 18 hours/day) and usually I would keep for about 2 weeks, never sleep in them. I hate wearing glasses and I never felt like it was a big deal to wear my contacts because they really didn't bother me at all.

    So the OD put me on these eyedrops with steroid and antibiotics, and i stopped wearing my contacts for about a month (the first week my eyes hurt a lot during the eyedrop time).

    So after the month I started testing out the dailies that she told me I would have to switch to.... I have tried:

    Acuvue moist - hated them
    biotrue - hated them more
    ciba vision dailies with aquacomfort - hated them
    All 3 of these were intolerable, esp in my one eye, it felt like there was a piece of dirt in there...
    tru eye - felt ok but bad vision in them
    and total 1 - feel ok in but seem to irritate my eyes, like after i wear them for 8 hours they feel gross and when i take them out my eyes look red and I need a day to "recover"

    Now, I tried out a fresh pair of my old acuvue oasys ones and they felt way way more comfortable than any of the dailies (although not as much as they did before - although I find myself wondering if its from the irritation of the dailies... )

    Anyways, most people seem to LOVE the dailies and say they are more comfortable but I feel just the opposite. But my OD seems very against me going back to the biweeklies... and I find her reasoning to be lacking, but I also dont want to damage my eyes -- but I also feel like the dailies ARE damaging my eyes!

    My OD is excellent at what she does, but I feel like maybe she is saying this only because she thinks I might get another infection...
    But she had also said the 'infection' was under my cornea I think, maybe that there was a small scratch (in both eyes??)...

    I can't afford to get a second opinion, I am 30, healthy, not on any meds and never had problems with my contacts before... I am hoping you can tell me:

    1. do you think she is being overly cautious?
    2. could it be the dailies themselves irritating my eyes?
    3. is it possible that my eyes (one in particular) are now 'rejecting' the contacts because I had an infection?

    Really appreciate any advice, love your blog!

  2. I was Googling "recurring pinkeye" and I came across your rebuttal of raw milk as a home remedy. Thank you! I have been fighting red, painful, inflamed, gooey eyes for weeks now. My eye doctor initially prescribed antibiotic/steroid drops. The gooeyness got better, but the irritation did not. I returned and he then said I was fighting a dryness issue and he gave me some artificial tear type drops. It's three weeks later now, and the gooeyness is back and the irritation is worse than ever. Hence my original google search. I was very close to buying raw milk to use in my eyes, until I read your comment. Thank you! I'm sorry you received such negative feedback from the other posters, but I for one, am very grateful for your comments. I plan on returning to my eye doctor once again, but do you have any input on my situation? What do you recommend for a chronic eye irritation that will not go away? Is it possible for my eye doctor to do a culture to see what is really going on? Thanks again! Elizabeth


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