Posters

Endogenous bacterial endophthalmitis "EBE": about 2 cases

Poster Details

First Author: M.Elmhadi MOROCCO

Co Author(s): N. Elhalouat   A. Alami   J. Laayoun   A. Bouzidi   S. Iferkhass   A. Laktaoui     

Abstract Details

Purpose:

Endogenous bacterial endophthalmitis, also called metastatic bacterial endophthalmitis, remains a diagnostic and therapeutic challenge. It is a rare and potentially sight-threatening ocular infection that occurs when bacteria reach the eye via the bloodstream, cross the blood–ocular barrier, and multiply within the eye. It usually affects immunocompromised patients. The majority of patients are initially misdiagnosed, then the purpose of this work is to show that ophthalmologists should be aware of this because prompt local and general management is required to save the eye and/or the patient’s life.

Setting:

Ophthalmology service - Military Hospital Moulay Ismail of Meknès - Morocco.

Methods:

We report the experience of two cases of EBE : A 65 years old asthmatic man, under corticotherapy, with recurrent otitis; and a 56 years old diabetic man, under insulin who also accuses right lumbar pain. Our two patients consulted for a painful red eye with a deep drop in visual acuity, evolving in a context of fever.

Results:

Examination at admission: Case 1: fever 39 °C. in the left eye: hyperhememic conjunctiva with oedematous cornea. Anterior chamber had severe fibrinous inflammation. for the rest: acute media otitis and upper left limb erysipelas. Eye sample from the anterior chamber isolated Pneumonae Streptococcus; Also found in blood culture. Case 2: fever 40 °C In the right eye: hyperhememic conjunctiva with oedematous cornea. Anterior chamber showed a hypopion. Eye sample from the anterior chamber isolated Echerichia Coli; Also found in blood and urine culture. Renal ultrasonography : pyelonephritis of the right kidney. Intensive treatment was initiated urgently with satisfactory evolution.

Conclusions:

Endogenous endophthalmitis usually occurs on a field of immunodepression, as is the case with our patients. In both cases presented, general sepsis precedes ocular signs. The rapid implementation of a general treatment (initial infectious focus treatment) and local adapted (general and intravitreal antibiotic ± posterior vitrectomy) is essential in order to save the eye of the patient or his life. Despite an aggressive therapeutic approach, the visual prognosis remains reserved. Raising the awareness of ophthalmologists and infectious diseases doctors would reduce the diagnostic delay in order to implement treatment in a short time and avoid permanent blindness.

Financial Disclosure:

None