[
    {
        "role": "user",
        "content": "I%20am%20on%20eye%20drops%20for%20scleritis%20one%20is%20called%20maxitrol%204%20times%20a%20day%20for%20a%20week%20then%203%20then%202%20then%201%20a%20day%20of%20the%20last%20week%20I%20am%20alson%20on%20Acular%20antiinflamitory%20eye%20drops%20for%20four%20weeks%20to%204%20times%20a%20day%20but%20not%20recuding%20what%20should%20I%20be%20aware%20of%20side%20effects%20and%20feeling%20ill%20I%20ma%20blind%20already%20so%20no%20sight%20at%20all"
    },
    {
        "role": "assistant",
        "content": "I\u2019m sorry to hear how difficult your situation is. Here\u2019s a clear, up-to-date summary of what you should be aware of given your treatments (Maxitrol and Acular eye drops) for scleritis\u2014and what actions to take if things get worse. This info doesn\u2019t replace medical advice; please stay closely connected with your eye doctor or ophthalmologist.\n\n---\n\n## 1. What these drops are, and why they\u2019re used\n\n- **Maxitrol** is a combination eye medication: it contains a corticosteroid (dexamethasone) plus antibiotics (neomycin and polymyxin B). The steroid helps reduce inflammation, and the antibiotics help prevent or treat infection. ([medicines.org.uk](https://www.medicines.org.uk/emc/product/841/smpc?utm_source=openai))  \n- **Acular** (ketorolac tromethamine) is a topical non-steroidal anti-inflammatory drug (NSAID). It also helps reduce inflammation, pain, and discomfort. ([safetyandquality.gov.au](https://www.safetyandquality.gov.au/medicine-finder/acular?utm_source=openai))  \n\nFor scleritis (a serious deep inflammation of the white part of the eyeball), stronger treatments\u2014systemic steroids or immunosuppressants\u2014are often needed, especially for severe or necrotizing scleritis. Just using topical drops may not always be enough. ([merckmanuals.com](https://www.merckmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/scleritis?utm_source=openai))  \n\n---\n\n## 2. Side effects you should watch out for\n\n### From **Maxitrol** (steroid + antibiotic drops)\n\nBecause of the corticosteroid component:\n\n- Increased eye pressure (can lead to damage to the optic nerve) and glaucoma. ([medicines.org.uk](https://www.medicines.org.uk/emc/product/841/smpc?utm_source=openai))  \n- Risk of cataract development (posterior subcapsular cataract) with long or frequent use. ([medicines.org.uk](https://www.medicines.org.uk/emc/product/841/smpc?utm_source=openai))  \n- Delayed healing of eye tissues; in conditions where tissue is already weakened (like thinning of the cornea or sclera), risk of perforation. ([medicines.org.uk](https://www.medicines.org.uk/emc/product/841/smpc?utm_source=openai))  \n- Possible hypersensitivity or allergic reactions. ([medicines.org.uk](https://www.medicines.org.uk/emc/product/841/smpc?utm_source=openai))  \n\nOther effects might include blurred vision, eye irritation, stinging, redness, eye discomfort. ([medicines.org.uk](https://www.medicines.org.uk/emc/product/841/smpc?utm_source=openai))  \n\n### From **Acular** (ketorolac \u2014 NSAID drops)\n\nCommon or possible issues include:\n\n- Burning or stinging upon applying the drops (very common). ([safetyandquality.gov.au](https://www.safetyandquality.gov.au/medicine-finder/acular?utm_source=openai))  \n- Redness, swelling of eyelids or eye, irritation of surface of the eye, blurred or worsening vision. ([safetyandquality.gov.au](https://www.safetyandquality.gov.au/medicine-finder/acular?utm_source=openai))  \n- Corneal problems (surface of eye): thickening, edema/swelling, thinning, delayed healing, possibly ulceration with long use. ([dailymed.nlm.nih.gov](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=c94644d3-7b64-4f3d-a0c7-12c77466a0fc&type=display&utm_source=openai))  \n- Allergic reactions; risk of eye infections especially if drops or bottle tip get contaminated. ([dailymed.nlm.nih.gov](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=c94644d3-7b64-4f3d-a0c7-12c77466a0fc&type=display&utm_source=openai))  \n- Increased eye pressure is possible. ([safetyandquality.gov.au](https://www.safetyandquality.gov.au/medicine-finder/acular?utm_source=openai))  \n- Rare but serious systemic reactions (if medication gets into your body in other ways): e.g. worsening asthma, breathing problems. ([dailymed.nlm.nih.gov](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=c94644d3-7b64-4f3d-a0c7-12c77466a0fc&type=display&utm_source=openai))  \n\n---\n\n## 3. Why you might be feeling very unwell, even without vision\n\nIf you've lost vision already, or are very close to that point, your condition\u2014or the treatment or both\u2014can affect you in other ways:\n\n- COVID-eye pain, headaches, sensitivity to light (photophobia), feeling \u201csick to your stomach\u201d from the general inflammation or from medications (especially steroids).  \n- If systemic corticosteroids ever get involved (which often happens in scleritis), those can cause serious side-effects: mood changes, high blood sugar, weight gain, risk of infections, high blood pressure, bone thinning, etc. ([medlineplus.gov](https://medlineplus.gov/ency/article/001003.htm?utm_source=openai))  \n- If your immune system is involved (autoimmune disease, etc.), or you\u2019re being evaluated for systemic treatment, your whole body can feel it\u2014tired, achy, abnormal temperature, etc.\n\n---\n\n## 4. What to monitor and when to call your doctor\n\nYou should seek urgent medical attention if you experience any of the following:\n\n1. **New or worsening pain** in your eye(s)  \n2. **Sudden change in vision**, especially further loss, flashes of light, or dark spots ([safetyandquality.gov.au](https://www.safetyandquality.gov.au/medicine-finder/acular?utm_source=openai))  \n3. **White spots or ulcers** on the eye surface ([dailymed.nlm.nih.gov](https://www.dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=c94644d3-7b64-4f3d-a0c7-12c77466a0fc&type=pdf&utm_source=openai))  \n4. **Increased redness or swelling** that\u2019s much worse than before or spreading  \n5. **Symptoms like difficult breathing, swelling of lips/tongue**, that might suggest a systemic allergic reaction (rare, but serious) ([medsafe.govt.nz](https://www.medsafe.govt.nz/Consumers/CMI/a/acular.pdf?utm_source=openai))  \n\nAlso, regularly check for:\n\n- Eye pressure (especially if using steroids)  \n- Office appointments to monitor progression or response  \n- Symptoms of infection (like discharge, green/yellow fluids)  \n\n---\n\n## 5. My concern: are topical drops enough?\n\nFrom what evidence suggests:\n\n- Topical corticosteroids and topical NSAIDs alone often aren\u2019t enough for *scleritis*, especially moderate or severe cases. You may need **systemic therapy**\u2014oral steroids, and possibly immunosuppressants or biologics (if an autoimmune cause) ([merckmanuals.com](https://www.merckmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/scleritis?utm_source=openai)).  \n- The fact that your vision is already lost or severely impacted suggests very severe disease; in those cases, more aggressive systemic treatment is usually necessary.  \n\n---\n\n## 6. Possible next steps you might ask your doctor about\n\n- Blood tests or imaging to see if there's an underlying cause (autoimmune disease, etc.).  \n- Systemic steroids (e.g., oral prednisone) or pulses of IV steroids if needed.  \n- Immune-suppressing medications if disease is recurrent or not responsive to standard treatments.  \n- Checking whether the cause is infectious (this changes treatment significantly).  \n- Monitoring organs/systems (liver, kidneys, blood sugar, etc.) if systemic therapy is involved.\n\n---\n\nI\u2019m truly sorry you\u2019re going through this. Because scleritis can progress rapidly, it\u2019s crucial to have an ophthalmologist (especially a specialist) evaluate frequently, and consider systemic treatment if you don\u2019t already have that plan in place.\n\nIf you like, I can walk through what systemic treatment might look like in your case, or help you think through questions to ask your provider. Do you want me to pull that together for you?"
    }
]