Spontaneous Subconjunctival Abscess: A Case Series and Review of the Literature

Subconjunctival abscesses are exceedingly rare in the absence of previous ocular trauma or surgery. Here, we report three such cases and review the current literature. Three male patients (ages 3, 36, and 66 years) developed a spontaneous subconjunctival abscess without prior ocular trauma or surgery. The pediatric patient developed symptoms after swimming in a pool, while the adult patients were healthcare workers; all were immunocompetent. Conjunctival cultures were negative. Two cases were treated medically, either with topical moxifloxacin or fortified vancomycin and tobramycin, and resolved without recurrence. In the third case, the abscess worsened despite topical moxifloxacin and oral trimethoprim-sulfamethoxazole and ultimately required surgical excision followed by fortified vancomycin and tobramycin. All three cases resolved without recurrence at one month. In summary, spontaneous subconjunctival abscesses can occur in the absence of prior ocular trauma or surgery. This series includes the first reported pediatric case of spontaneous subconjunctival abscess and demonstrates the utility of AS-OCT in characterizing abscess morphology. Broad-spectrum antibiotics should be considered empirically, even with negative cultures, and worsening cases may require surgical excision.