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Clostridium bifermentans panophthalmitis after penetrating eye injury
U Rehany1, Y Dorenboim, E Lefler
1Department of Ophthalmology, Nahariya Medical Center, Israel.
Background:
Intraocular and orbital anaerobic infections usually result from penetrating eye injuries with soil-contaminated foreign bodies. The outcome of these infections almost always has been loss of the globe, despite appropriate antibiotic and surgical treatment. The most prevalent etiologic microbe of anaerobic panophthalmitis is Clostridium perfringens.
Case Report:
To the authors' knowledge, this is the first report of panophthalmitis caused by Clostridium bifermentans after penetrating eye injury. The patient had severe signs and symptoms of intraocular and orbital infection, with early total loss of visual function. Parenteral and intravitreal therapy with penicillin and clindamycin, administered according to antibiotic sensitivity studies of cultures from the anterior chamber and vitreous, did not restore vision.
Conclusions:
Due to the early devastating outcome, penetrating eye injuries with soil-contaminated foreign bodies should be regarded as being at high risk for clostridial infection and should be treated promptly with vitrectomy and antibiotic therapy for aerobic and anaerobic infection.
Insights
Penetrating eye injuries with soil contamination risk Clostridium infections, leading to globe loss. Prompt vitrectomy and broad-spectrum antibiotics are crucial for managing these severe anaerobic eye infections.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Intraocular and orbital anaerobic infections often stem from penetrating eye injuries involving soil-contaminated foreign bodies.
- Clostridium perfringens is the most common cause of anaerobic panophthalmitis, frequently resulting in globe loss despite treatment.
- Prompt recognition and management are vital due to the high risk of severe outcomes.
Observation:
- This case report details the first known instance of panophthalmitis caused by Clostridium bifermentans following a penetrating eye injury.
- The patient presented with severe intraocular and orbital infection, leading to rapid and complete loss of visual function.
- Standard antibiotic treatments, including penicillin and clindamycin, were ineffective in preserving vision.
Findings:
- Clostridium bifermentans can cause severe panophthalmitis after penetrating eye trauma.
- Aggressive anaerobic infections can lead to devastating and irreversible vision loss.
- Antibiotic sensitivity-guided therapy may not always prevent catastrophic outcomes in severe clostridial panophthalmitis.
Implications:
- Penetrating eye injuries with soil contamination warrant immediate high-risk assessment for clostridial infections.
- Prompt surgical intervention, such as vitrectomy, combined with comprehensive antibiotic therapy (aerobic and anaerobic coverage), is essential.
- Early and aggressive management is critical to mitigate the risk of globe loss and preserve visual function in such cases.