CLINICAL OUTCOMES AFTER SEVERE CORNEAL ULCERATION DUE TO PSEUDOMONAS IN A CONTACT LENS WEARER. TREATMENT, MONITORING, CLINICAL AND IMAGING FINDINGS.

To present the detailed course of an ulcerative keratitis due to pseudomonas infection and highlight the importance of photo monitoring, as well as to assess the subjective (visual acuity) and objective (imaging findings) outcomes.

A 25-year-old male presented to the ophthalmology emergency department complaining of blurred vision and sensitivity to light for 24 hours in the right eye. Severe pain, tearing and eye redness pre-existed for 2 days. From his history, he mentioned wearing monthly-disposable soft contact lenses prior to the onset of symptoms.

The patient underwent full ophthalmological examination. Visual acuity was hand movement in the right eye, while slit-lamp examination revealed a central corneal ulcer. Corneal scrapings and samples from the contact lens case’s liquid were collected for cultures and antibiograms. The patient was admitted to the ophthalmology clinic and intensive broad spectrum antibiotic therapy (topical fortified vancomycin,  ceftazidime and levofloxacin as well as oral ciprofloxacin) was initiated. We performed daily re-examinations to assess the progress of the ulcer and to exclude the possibility of complications, especially corneal perforation. Daily photos were obtained to monitor the size of the epithelial defect and the infiltrate.

Culture of corneal scrapings grew antibiotic-sensitive Pseudomonas, while the liquid’s cultures grew (apart from Pseudomonas) Enterobacter cloacae complex and Stenotrophomonas maltophilia. Following the antibiogram, we continued the treatment with topical antibiotic therapy in high doses. After 12 days he was discharged from the hospital with instructions to continue treatment at home. Dexamethasone drops were added to help with the stromal infiltrate. After one month of treatment, clinical improvement was achieved, nevertheless a central stromal haze remained. Corneal topography was unable to be performed. Anterior segment OCT(Optical Coherence Tomography) clearly documented the scar’s margins and the amount of stromal defect.

Pseudomonas related infectious keratitis is a common cause of blindness globally, with contact lens wear being the main predisposing factor in developed countries. Early diagnosis and prompt treatment is the keystone to avoid serious complications such as corneal perforation and vision impairment. In this case report, the importance of daily documentation through photographs is highlighted. Culture of corneal scrapings is an essential tool for treatment optimization. Anterior segment OCT can provide useful information regarding visual prognosis and further management.