Why is my client seeing spider and experiencing pain after VKH treatment?

Question

Hello doctor,

My client was diagnosed with VKH five years ago.. For the past three months, she has been claiming that she has parasites in her eyes, and now she sees spiders. The spiders are small, pure white, and are walking around the webbing. They are biting her eyes, and she cannot focus well on them, but they scare her badly. She is experiencing a lot of pain in her eyes due to spiders biting her. She was also hospitalized for suicidal tendencies but was released since she was no longer a threat to herself. However, she still sees these visions or images. She has had a test done, but they were unable to get her right eye focused on the blue light when they tried looking in the back of the eye. She is currently on Lisinopril 20 mg, Oxycodone 10 325 mg, Doxepin 50 mg, Temazepam 15 mg, Diclofenac 50 mg, Prednisolone 1 % eye drops, Hydrochlorothiazide 25 mg, and Fentanyl 50 mcg. Any insight would be helpful. Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query, and I can understand your concern.

In my opinion, these are all signs of neurological problems rather than direct ophthalmic problems. Spiders can be correlated with floaters, but they cannot bite eyes. Moreover, as you mentioned, the retina was crumbled and put together can be correlated to fluid collected in the retina which must have subsided with treatment, but we cannot explain other symptoms like suicidal tendencies, spiders biting eyes with ophthalmic manifestations. These could be due to neurological problems associated with VKH (Vogt-Koyanagi-Harada disease), and a neurologist can only help her. They will examine her and then start the medication. I hope this information will help you. Thank you.