Subjectives: To describe the history, clinical presentation, and successful surgical and antibiotic management of a case of endophthalmitis with infectious scleritis caused by Streptococcus pneumoniae.
Methods: A 79-year-old female presented with blurred vision with severe pain in her right eye. She ocular trauma history and but ever received surgeries for both eyes cataract and right pterygium years ago. The patient was treated by her referring ophthalmologist with some topical medication without clinical improvement. Evaluation consisted of slit-lamp examination, surgical exploration with tissue cultures and histology.
Results: Under the impression of endogenous endophthalmitis with infectious scleritis, the patient received the operation of vitrectomy, scleral patch grafting with amniotic membrane transplantation, intravitreal injection of Vancomycin and Ceftazidime. Culture results revealed Streptococcus pneumoniae and intravenous Ceftriaxone was given. Systemic work-up for suspected source of endogenous endophthalmitis was performed, but there wasn’t suspicious source of infection. Therefore, scleral melting site (previous pterygium surgery wound) as the route of infection was favored. With the gradually improvement of her Intraocular inflammation, systemic antibiotics were shifted to oral Levofloxacin with fully recovery.
Conclusions: Necrotizing scleritis may occurred after previous pterygium surgery performed even many years ago, and which may induced further infection as endophthalmitis. Well history taking, proper and early treatment may prevent the development of the potential blindness disease. |
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