Case Reports

Corneal ulcer after uneventful cataract surgery in a patient with eyelid coloboma

Case Report Details

First Author: G.Siasou GREECE

Co Author(s):    I. Akram   D. Dragnev                 

Abstract Details

Purpose:

To present a case of corneal ulcer with hypopyon after uncomplicated cataract surgery in a diabetic patient with pre-existent surgically induced lower lid coloboma and to investigate the possible causes.

Setting:

St. Helens and Knowsley Teaching Hospitals NHS Trust, UK.

Report of Case:

A 65 years old diabetic male patient presented with symptoms of pain and deteriorating vision in the right eye 8 days after ipsilateral routine phacoemulsification and posterior chamber intraocular lens implantation. He was on topical treatment with g. chloramphenicol 0.5% qid, g. dexamethasone 0.1% 2-hourly and g. bromfenac 0.9 mg/ml bd according to the post-operative protocol for diabetic patients. Slit-lamp examination revealed a 4.5 mm in diameter inferior corneal ulcer corresponding to the area of the cornea which was exposed due to the pre-existent lower lid coloboma, stromal oedema, Descemet folds, negative Seidel test, anterior uveitis and 3 mm hypopyon. Since there was no view of the fundus, a B-scan was performed which showed flat retina and clear vitreous without signs of endophthalmitis. Corneal scrapes were sent for microbiology and culture and the patient was started on broad spectrum topical antibiotics.

Conclusion/Take Home Message:

The development of the corneal ulcer was attributed to a combination of factors including diabetes, the presence of corneal exposure due to the lower lid coloboma, the frequent use of topical medication with preservatives and the combined treatment with dexamethasone and bromfenac. Taking into consideration the reported in literature possible corneal toxicity of topical non-steroidal anti-inflammatory drugs (NSAIDs), we would suggest careful administration of NSAIDs and use of preservative-free topical medication following cataract surgery in patients with predisposing conditions such as corneal exposure or other corneal pathology leading to dry eye syndrome in order to prevent the occurrence of corneal ulceration or corneal melt. No financial disclosure.

Financial Disclosure:

None