Fecal-related self-inflicted conjunctivitis in a pediatric patient with major depressive disorder

A 16-year-old girl with major depressive disorder suffered from a recurrent polymicrobial conjunctivitis, culture-positive for Escherichia coli, that persisted over several months despite evaluation by multiple specialists and appropriate antibiotic treatment. Ultimately, a brown malodorous mass, concerning for possible fecal matter, was noted in the inferior fornix of the left eye and sent for pathology review. Pathology results of the mass revealed degenerated vegetable matter debris with associated bacterial colonies consistent with fecal matter. Discussions were held with the patient, her parents, and her primary care provider. The decision was made to involve psychiatry to ensure the self-harm behavior did not continue and further place the patient at risk of vision loss. This report emphasizes that ophthalmic issues can sometimes be manifestations of an underlying psychiatric condition, highlighting the importance of a multidisciplinary treatment approach.