gms | German Medical Science

Purpose: To present two cases of endophthalmitis after minor ocular trauma.

Methods:

1^st case: A 80 yo farmer presented with ocular pain, redness, blurring of vision and photophobia in his right eye (RE) with <24h onset. The previous day the patient had heavy work done in the fields and he mentioned that at some time he was rubbing his RE. In clinical examination there was conjuctival discharge and small epithelial corneal erosion over the corneal tunnel entry site of a previous (11 months earlier) phaco procedure. His visual aquity (VA) was 6/10, there were ~50 aqueous cells and vitreous cells±. Conjuctival scraping was sent for microbiological investigation and the patient was commenced on endophthalmitis treatment (Solvetan, Voncon, Tobrex, Exocin). Gram staining revealed a Gram (-) microorganism, the culture revealed Aeromonas hydrophila (an extremely haemolytic and virulent species) and the treatment was modified according to the antibiogram.

2^nd case: A 74 yo male presented with a superficial lamellar linear 6mm laceration involving the cornea (7 o\'27clock) and the neighboring sclera. The trauma was done the previous day by a piece of wood the patient was working on. On clinical examination the patient had Tyndal + and ~10 aqueous cells. He was commenced on tobramycin drops and sent home. Two days later the patient returned with moderate pain, mild blurring of vision, Tyndal + and aqueous cells 20. The patient was commenced on endophthalmitis treatment.

Results: 1^st case: Under endophthalmitis treatment the vision was fully recovered 30 days later. 2^nd case: Under endophthalmitis treatment the vision and intraocular inflammation were fully recovered 14 days later.

Conclusion: For globe injuries occurring in rural setting, endophthalmitis may result even after minor ocular trauma, presumably due to soil contamination. Early recognition of clinical signs and immediate initiation of treatment can have very good results.