I've been experiencing recurring eye symptoms, including discharge, for years, and was hospitalized last year with a similar condition diagnosed as staph (Staphylococcus) infection, but I'm concerned it may be a chronic fungal infection or inflammatory disorder, what could be the underlying cause of my symptoms?

Recurrent Eye Discharge: Likely Chronic Staphylococcal Blepharokeratoconjunctivitis, Not Fungal Infection

Your recurring eye symptoms with discharge are most likely caused by chronic staphylococcal infection of the eyelid margins and ocular surface, not a fungal infection, and antifungal medications would not help your condition. 1

Why This Is Not a Fungal Infection

Your physicians are correct in not prescribing antifungals because:

• Fungal eye infections present very differently from what you describe. Fungal keratitis typically shows a dry (not wet/discharge-producing) appearance with feathered edges, satellite lesions, or a ring infiltrate pattern on the cornea itself 1
• Fungal conjunctivitis is extremely rare in immunocompetent patients and would require specific risk factors like severe immunosuppression, chronic steroid use, or penetrating eye trauma 2, 3
• Discharge is not a primary feature of fungal eye disease—fungal infections cause corneal infiltrates and stromal involvement rather than the purulent or mucopurulent discharge typical of bacterial infections 1

Understanding Your Staphylococcal Infection

Staphylococcus aureus causes chronic, recurring eye infections that match your description:

• Staph produces recurrent discharge (purulent or mucopurulent) that can persist for years with periodic flares 1
• The bacteria colonize the eyelid margins, eyelashes, and ocular surface, making reinfection common even after treatment 1
• Chronic staphylococcal blepharokeratoconjunctivitis presents with redness, discharge, crusting of eyelids, and foreign body sensation that recurs over years 1

Critical Warning Signs to Monitor

You must watch for these vision-threatening complications:

• Corneal involvement: Any decrease in vision, severe pain, or light sensitivity requires immediate ophthalmology evaluation 1, 4
• Corneal infiltrate or ulcer: This can progress to perforation within 24-48 hours if caused by certain bacteria 1, 4
• Always have your cornea examined with fluorescein staining during flares to detect early corneal involvement 4

Treatment Algorithm for Chronic Staphylococcal Eye Disease

Acute Flare Management

• Topical fluoroquinolone antibiotics (moxifloxacin 0.5% or besifloxacin 0.6%) four times daily for 5-7 days during active discharge 1
• Warm compresses twice daily to eyelid margins to reduce bacterial load 1
• Eyelid hygiene: Diluted baby shampoo or commercial eyelid scrubs to mechanically remove bacteria from lash bases 1

Long-Term Prevention Strategy

• Decolonization is essential to prevent recurrence since S. aureus colonizes your nasopharynx, oropharynx, and ocular surface 1
• Consider nasal mupirocin ointment twice daily for 5 days monthly to reduce nasal carriage (discuss with your physician) 1
• Daily eyelid hygiene even when asymptomatic—this is the most important preventive measure 1
• Replace eye makeup and contact lenses (if applicable) during active infection 1

When Topical Treatment Fails

• Methicillin-resistant S. aureus (MRSA) is increasingly common and resistant to fluoroquinolones 1
• If symptoms persist despite treatment, request culture and sensitivity testing of eye discharge 1
• MRSA requires fortified vancomycin eye drops (50 mg/mL) every 1-2 hours initially 1
• Oral antibiotics are rarely needed unless there is extension beyond the eye surface 1

Common Pitfalls Causing Treatment Failure

• Inadequate treatment duration: Staphylococcal infections require at least 5-7 days of antibiotics, and Moraxella (another bacteria) may require up to 42 days 1
• Failure to address eyelid colonization: Treating only the conjunctiva without eyelid hygiene leads to immediate reinfection 1
• Not replacing contaminated items: Eye makeup, contact lens cases, and pillowcases harbor bacteria 1
• Stopping treatment when symptoms improve: Complete the full antibiotic course even if discharge resolves 1

Why Your Physicians Don't See the Discharge

Discharge production is intermittent in chronic staphylococcal disease:

• You may have active discharge at home but it resolves by the time you reach the clinic 1
• Take photographs of your eyes during symptomatic periods showing the discharge to document for your physician 1
• Request examination during an active flare rather than between episodes 1

Alternative Diagnoses to Consider

If standard staphylococcal treatment fails completely, consider:

• Chlamydial conjunctivitis: Causes chronic follicular conjunctivitis with mucopurulent discharge, requires systemic antibiotics (azithromycin 1g single dose or doxycycline 100mg twice daily for 7 days) 1
• Ocular mucous membrane pemphigoid: Chronic autoimmune condition causing recurrent inflammation, discharge, and progressive scarring—requires systemic immunosuppression 1
• Ligneous conjunctivitis: Rare genetic plasminogen deficiency causing recurrent pseudomembrane formation with mucoid discharge 1

Next Steps

1. Document your symptoms with dated photographs during flares
2. Request culture and sensitivity testing of eye discharge during next episode
3. Implement daily eyelid hygiene as preventive maintenance
4. Demand fluorescein corneal examination during symptomatic periods to rule out keratitis 4
5. If MRSA is confirmed, discuss nasal decolonization protocols 1