November 2011


Steroid associated infective keratitis

Case studies for caution

Volume 40, No.11, November 2011 Pages 888-890

Neil Sharma

Ethan Nguyen

Ju-Lee Ooi

John Males

Case study 1

Betty, 78 years of age, presented to the emergency department with an acutely painful discharging left eye on the background of a complex ocular history. While living overseas she had developed left eye herpes keratitis for which she sought treatment from an ophthalmologist. She had initially been prescribed oral valacyclovir tablets and then ongoing topical corticosteroid eye drops (dexamethasone 0.1%) and acyclovir eye ointment four times daily.

On arrival in Australia, Betty consulted a general practitioner for continuation of her treatment. The GP provided her with ongoing prescriptions for dexamethasone eye drops but inadvertently omitted the acyclovir eye ointment. No ophthalmology follow up was organised. Betty continued the dexamethasone drops unmonitored for several months.

On examination in the emergency department, Betty had no perception of light in her left eye. She had significant periorbital oedema and conjunctival chemosis. There was a large corneal abscess involving almost the entire corneal surface (Figure 1). There was an area of corneal thinning nasally, with evidence of corneal perforation. The anterior chamber was flat and the iris plugged the corneal perforation. She was febrile at 38ºC. Betty was admitted to hospital for treatment of a perforated corneal abscess. She was treated with intravenous antibiotics (ceftriaxone 1 g/day) and hourly fortified antibiotic eye drops (cephalothin 5% and gentamicin 0.9%). Despite several days of treatment, the eye was nonsalvageable and required evisceration (removal of the cornea and intraocular contents). The wound was left open to allow drainage of residual infection.

She underwent fitting of an ocular prosthesis 5 months later.

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