Posters

A cow's tail tale

Poster Details

First Author: S.Nabili UK

Co Author(s):                        

Abstract Details

Purpose:

Fungal keratitis management can be challenging, particularly if clinical picture is confused with bacterial involvement. This case illustrates an infectious keratitis with a mixed bacterial and fungal aetiology which was initially treated as bacterial and premature steroid use resulted in the deterioration of clinical picture.

Setting:

Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK

Methods:

A prospective case review A 61 year old previously healthy farmer with no previous eye disease struck by a cow’s tail in the right eye two days prior to presentation with a red painful eye and hand movements vision. On examination, a corneal ulcer with a stromal infiltration was noted. Following corneal scraping, the commencement of intensive topical Ofloxacin 0.3% and oral Ciprofloxacin 500 mg BID resulted in a favourable response Gram staining and culture failed to detect any organisms. As Patient continued to improve after 5 days, topical steroid commenced under close observation.

Results:

After 2 days, the right vision deteriorated to hand movements. The ulcer size increased to 4 mm x 4.5 mm with a dense infiltration, fluffy borders and satellite lesions . Steroid stopped and ulcer was rescraped for microbiological investigation which isolated Fusarium Solani species. Further tests showed sensitivity to Econazole and Voriconazole. Intensive topical Econazole 1% hourly and oral Voriconazole. Patient showed a gradual improvement. After 4 months, the right cornea developed a dense paracentral stromal scar. With view of visual rehabilitation, a Triple procedure was performed after 6 months. The postoperative period was uneventful.

Conclusions:

In this case, this farmer’s infectious keratitis developed by a cow’s tail strike which must have implanted the cornea with vegetative materials.The use of topical broad-spectrum topical antibiotics may have provided a non-competitive environment for fungi to grow. In addition, the use of topical corticosteroid enhanced the growth of fungi while suppressing host immune response. This case recalls the necessity of judicious use of steroid in the infectious keratitis. In particular, the corticosteroid use in the management of agricultural related infectious keratitis should be avoided or delayed until the confirmation of negative fungal growth by microbiology.

Financial Disclosure:

None