Posters

Bilateral spontaneous corneal perforation due to presumed endogenous endophthalmitis

Poster Details

First Author: P. Pontón SPAIN

Co Author(s):    I. Sanchez   A. Hajjar   R. Portilla   R. Hernandez   J. Alonso        

Abstract Details

Purpose:

To describe a rare case of spontaneous bilateral corneal perforation in a terminally ill elderly woman with severe pulmonary hypertension, anaemia and severe cognitive impairment at presentation.

Setting:

Department of Ophthalmology, University Hospital of Burgos, Burgos, Spain.

Methods:

A case report and retrospective chart review. An 89 year-old woman in poor general health was brought to the emergency department by a family member. The patient was on hydrocortisone cream for presumed viral conjunctivitis with no improvement. Initial assessment showed bilateral mucopurulent discharge and ophthalmological consult has been requested.

Results:

Eye examination revealed bilateral total corneal abscesses with inferior iris prolapse which self-sealed the spontaneous perforations. Orbital computerised tomography showed features suspicious of endophthalmitis. The patient was admitted for systemic antibiotic treatment. After assessment by the medical team the patient was diagnosed with end-stage generalised sepsis. Bilateral involvement indicated endogenous source of infection. Arterial blood pressure was too low to obtain a blood sample for culture. The only microbiological exam available was uroculture extracted by bladder probing which showed more than 100.000 UFC/ml of Candida albicans. The patient’s condition quickly deteriorated and she died from multi-organ failure hours later.

Conclusions:

Careful ophthalmological examination can help to direct the management of systemically ill patient when time is critical. Unfortunately in this case despite the best efforts and multidisciplinary approach it was simply too late to overcome the infection and prevent the tragic loss of life.

Financial Disclosure:

NONE