Escherichia coli Panophthalmitis after Pecking by a Great Egret (Ardea alba)

We report a case of open globe injury caused by Ardea albapecking that resulted in Escherichia colipanophthalmitis. A woman in her 70s complaining of ocular pain was referred to our hospital because her right eye had been pecked by an A. alba2 days earlier. Visual acuity in her right eye was reduced to light sensation. The right conjunctiva became hyperemic and edematous with swelling of the right upper eyelid. The upper side of the right cornea was densely cloudy with focal defect. Ultrasonography showed a thick sclera and choroid-like structure. Pathological investigation of a scraped sample from the infected site revealed gram-negative rods; E. coli was isolated. She had fever with elevated serum C-reactive protein levels and leukocytosis confirmed by laboratory examination. Topical levofloxacin and cefmenoxime and intravenous fosfomycin and aspoxicillin were initiated, but the right cornea melted near the perforated site with leakage of the eyeball contents on the next day. We decided to perform eye evisceration because of difficulty in controlling corneal melting and panophthalmitis. Her general state recovered the day after surgery. Orbital cellulitis improved gradually with normal C-reactive protein levels and white blood cell counts. As ocular injury caused by birds could become severe and cause ocular infection and visual dysfunction, it is important to exercise caution in the vicinity of wild birds, especially when they are aggressive.