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Necrotizing destruction of the ocular adnexa by Pseudomonas aeruginosa
F J Steinkogler1, V Huber-Spitzy
1Second University Eye Clinic, Vienna, Austria.
Abstract:
In a six weeks old boy, a necrotizing Pseudomonas infection had destroyed nearly the whole lid apparatus, the lacrimal structures of the right eye and the medial canthal region, the medial thirds of the eyelids and the lacrimal passages on the left side. The infection was only controlled by intensive antibiotic therapy after more than two weeks. The exposure keratitis of the right eye was followed by corneal perforation, two months after the beginning of the therapy. A keratoplasty was performed, but soon a staphyloma and later, dense scarring developed. After the haematological and immunological situation was under control we could contemplate covering the large defect in the medial canthal area (open right canalis nasolacrimalis) at the age of seven months. The right lower lid has to be reconstructed later. The left eyelid defects have closed by spontaneous granulation. The little boy is no longer receiving antibiotic treatment and is developing very well.
Insights
A severe Pseudomonas infection caused extensive damage to a baby's eyelids and tear ducts. Surgical reconstruction and antibiotics were necessary for recovery, with ongoing monitoring for the right eye.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Reconstructive Surgery
Background:
- Necrotizing Pseudomonas infections can cause severe tissue destruction.
- Early and aggressive treatment is crucial for managing such infections in infants.
Observation:
- A six-week-old infant presented with extensive necrotizing Pseudomonas infection affecting eyelids, lacrimal structures, and the medial canthal region.
- The infection required over two weeks of intensive antibiotic therapy for control.
- Complications included exposure keratitis, corneal perforation in the right eye, necessitating keratoplasty, followed by staphyloma and scarring.
Findings:
- The infant underwent reconstructive surgery for a large medial canthal defect, involving the right nasolacrimal canal.
- Left eyelid defects healed via spontaneous granulation.
- The patient's hematological and immunological status was stabilized before surgical intervention.
Implications:
- This case highlights the devastating potential of Pseudomonas infections in neonates and the complexity of managing resulting ocular and facial defects.
- Successful management involves a multidisciplinary approach, including intensive antibiotics, reconstructive surgery, and long-term follow-up.
- Reconstructive surgery for the lower eyelid is planned for a later stage.