Sterile endogenous panophthalmitis with uncontrolled diabetes

A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.