Fulminating panophthalmitis due to exogenous infection with Bacillus cereus: report of 4 cases

Bacillus cereus is a seldom recognised but important cause of panophthalmitis. Although most reported cases have been the result of endogenous infection, we have recently seen 4 cases that followed ocular trauma. In each instance a fulminating panophthalmitis developed, accompanied by fever and leucocytosis. Despite prompt therapy all eyes were rapidly lost. In view of the selective antibiotic sensitivities of this organism and the fulminating course of the disease, conventional approaches to therapy, including standard prophylactic antibiotic regimens, are unlikely to be successful in such cases. Analysis of our cases suggest that ocular infection with B. cereus has certain features that may allow a provisional diagnosis to be made before isolation of the organism. Early recognition and prompt institution of effective therapy may lead to salvage of these eyes in the feature.