A tragic tale of a lost eye an unusual case of endogenous endophthalmitis
Christina Ann Mathew
Jawaharlal Nehru Medical College, India
: Int J Ophthalmic Pathol
Abstract
Endogenous endophthalmitis is a rare and potentially devastating intraocular infection accounting for approximately 2% - 8% of all cases of endophthalmitis. Identified risk factors include chronic diseases, immunocompromised states and invasive medical procedures. This report illustrates an unusual presentation of endogenous endophthalmitis involving the patient’s LE and caused by Microsporidia. A 42 year old male presented with complaints of rapid loss of vision in his left eye (LE) over the course of 3 days, which was initially painful and became painless later. He had no history of intraocular surgery or trauma. However, he was a known diabetic and hypertensive with chronic kidney disease for which he was on haemodialysis. On examination, he had nil perception of light in his LE. His eyelashes were matted with mucopurulent discharge and his lids were oedematous. His conjunctiva was congested and his cornea had stromal oedema with infiltrates. The anterior chamber was flat and irregular with lens details obscured. His fundus was not seen due to hazy media. His right eye had normal anterior segment findings but fundus examination revealed early signs of diabetic and hypertensive retinopathy. A presumptive diagnosis of endogenous endophthalmitis was made. The patient was treated with intravitreal injection of vancomycin and ceftazidime along with topical Moxifloxacin eyedrops and systemic oral as well as intravenous antibiotics. On culture of his intravitreal tap, Microsporidia was demonstrated. Visual prognosis was poor and the patient was unwilling for destructive procedures such as enucleation. At 6 months follow up, the patient had LE pthisis bulbi. Endogenous endophthalmitis requires a high degree of clinical suspicion for early diagnosis and initiation of treatment. Intravitreal antibiotics along with topical and systemic antibiotics as well as vitrectomy remain the cornerstone of effective management. However, due to delay in diagnosis, the visual outcome is usually poor.
Biography
Christina Ann Mathew is currently a Postgraduate Student in Ophthalmology at Kasturba Medical College, Manipal, Mangalore, India. She completed her under graduation (MBBS) from Jawaharlal Nehru Medical College, Nagpur, India in 2015.
