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Spontaneous hyphaema and corneal haemorrhage as complications of microbial keratitis
1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.
Abstract:
Hyphaema developed spontaneously in 16 of 458 patients with microbial keratitis treated at two centres on the East and West Coasts of the United States. Chronic corneal conditions were often present, and three cases had rubeosis iridis. Inflamed iris vessels were assumed to be the source of the haemorrhage. The hyphaemas tended to persist longer than is usual, particularly when coincident with a hypopyon. Recurrent hyphaemas are reported in two patients from outside this series. Spontaneous corneal haemorrhage was seen in three cases. Subepithelial bleeding settled rapidly, but a combined midstromal and pre-Descemet's haematoma cleared more slowly. Anterior segment bleeding was significantly associated with advanced age, female sex, infection with Gram-positive organisms, and hypopyon.
Insights
Spontaneous hyphaema occurred in microbial keratitis patients, often linked to chronic conditions and Gram-positive infections. These bleeding events, especially with hypopyon, showed prolonged persistence and specific risk factors.
Area of Science:
- Ophthalmology
- Microbial Keratitis Research
- Anterior Segment Eye Disease
Background:
- Microbial keratitis can lead to complications affecting the anterior segment of the eye.
- Understanding spontaneous bleeding events is crucial for managing severe ocular infections.
Observation:
- Spontaneous hyphaema (blood in the anterior chamber) was observed in 16 out of 458 patients with microbial keratitis.
- Patients often had pre-existing chronic corneal conditions, and some presented with rubeosis iridis.
Findings:
- Inflamed iris vessels were the presumed source of bleeding.
- Hyphaemas persisted longer than typical, particularly when accompanied by hypopyon (pus in the anterior chamber).
- Anterior segment bleeding showed significant associations with advanced age, female sex, Gram-positive bacterial infections, and hypopyon.
Implications:
- These findings highlight specific risk factors and clinical presentations associated with spontaneous hyphaema in microbial keratitis.
- Recognizing these associations can aid in predicting and managing prolonged or recurrent bleeding episodes.
- Further research into the mechanisms of vascular fragility in infectious keratitis is warranted.